Hybrid Ablation of Atrial Fibrillation: A Contemporary Overview
Abstract
:1. Introduction
2. Rationale of Hybrid Ablation of Atrial Fibrillation
3. Current Guidelines
4. Preprocedural Screening
5. Procedural Workflow and Techniques
5.1. Transvenous Radiofrequency Catheter Ablation
5.2. Surgical Thoracoscopic Epicardial Ablation
5.3. Unilateral Approach
5.4. Bilateral Approach
5.4.1. Fusion Technique
5.4.2. Convergent Technique
5.5. Thoracoscopic Left Atrial Appendage Occlusion
6. Clinical Outcomes and Future Perspectives
7. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Reference | Study Category | N. of Patients | Paroxysmal AF/Persistent AF (n) | First Procedure (+/−) | Surgical Technique | Lesions Performed | Complications | Follow-Up (Months) | Freedom from AF |
---|---|---|---|---|---|---|---|---|---|
Wolf et al., 2005 [38] | Observational | 27 | 18/9 | + | Bilateral | PVI + LAAc | 3 minor, 3 major | 6 | 91.3% |
Mahapatra et al., 2011 [39] | Observational | 15 | 0/15 | − | Unilateral | PVI, roof line, mitral line, LAAc, GPa | 0 | 20.7 | 86.7% |
La Meir et al., 2013 [40] | Observational | 63 | 35/0 | + | Unilateral | PVI, inferior line, roof line, isthmus, endocardial, LAAc | 0 | 12 | 91.4% |
Maesen et al., 2018 [41] | Observational | 64 | 30/34 | +(66%) | Unilateral | PVI, roof line, inferior line, LAAc | 2 minor, 1 major | 36 | 80% |
Pison et al., 2012 [42] | Observational | 26 | 15/11 | + | Unilateral | PVI, CTI, SVCi, intercaval line, mitral line | 1 minor | 12 | 83% |
Pison et al., 2014 [43] | Observational | 78 | 29/49 | +(68%) | Unilateral | PVI, roof line, inferior line, mitral line, CTI, intercaval line, LAAc, GPa | 6 minor | 12 | 82% (persistent AF), 76% (paroxysmal AF) |
Bulava et al., 2015 [45] | Observational | 50 | 0/50 | + | Bilateral | PVI, roof line, inferior line, LAAc, intercaval line, GPa | 7 major, 10 minor | 12 | 94% |
Richardson et al., 2016 [47] | Observational | 83 | 0/83 | + | Bilateral | PVI, roof line, inferior line, intercaval line, LAAc | 6 minor, 1 major | 12 | 71% |
Muneretto et al., 2017 [46] | Observational | 100 | 0/100 | +(45%) | Fusion | Box Lesion | 3 minor, 3 major | 12 | 88% |
De Lurgio et al., 2020 [26] | RCT | 102 | 0/102 | + | Subxiphoid | PVI, PWI, CTI | 8 major | 12 | 67.7% |
Complication | Complication Rate | Management |
---|---|---|
Mortality | 0.2% | - |
Stroke | 0.3% | Conservative/interventional |
Severe bleeding | 1.6% | Reintervention |
Cardiac perforation | 0.3% | Conversion to sternotomy |
Phrenic nerve injury | 0.3% | Conservative (can be transient) |
Atrio-ventricular block or sinus node dysfunction | 0.6% | Permanent pacemaker implantation |
Atrio-esophageal fistula | 0.4% | Surgery |
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Marini, M.; Pannone, L.; Della Rocca, D.G.; Branzoli, S.; Bisignani, A.; Mouram, S.; Del Monte, A.; Monaco, C.; Gauthey, A.; Eltsov, I.; et al. Hybrid Ablation of Atrial Fibrillation: A Contemporary Overview. J. Cardiovasc. Dev. Dis. 2022, 9, 302. https://doi.org/10.3390/jcdd9090302
Marini M, Pannone L, Della Rocca DG, Branzoli S, Bisignani A, Mouram S, Del Monte A, Monaco C, Gauthey A, Eltsov I, et al. Hybrid Ablation of Atrial Fibrillation: A Contemporary Overview. Journal of Cardiovascular Development and Disease. 2022; 9(9):302. https://doi.org/10.3390/jcdd9090302
Chicago/Turabian StyleMarini, Massimiliano, Luigi Pannone, Domenico G. Della Rocca, Stefano Branzoli, Antonio Bisignani, Sahar Mouram, Alvise Del Monte, Cinzia Monaco, Anaïs Gauthey, Ivan Eltsov, and et al. 2022. "Hybrid Ablation of Atrial Fibrillation: A Contemporary Overview" Journal of Cardiovascular Development and Disease 9, no. 9: 302. https://doi.org/10.3390/jcdd9090302