Characterizing Recurrence Following Hybrid Ablation in Patients With Persistent Atrial Fibrillation

Authors

David C. Kress, Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke’s Medical CentersFollow
Lynn Erickson, Advocate Aurora Research Institute, Advocate Aurora HealthFollow
Tadele W. Mengesha, Advocate Aurora Research Institute, Advocate Aurora HealthFollow
David Krum, Advocate Aurora Research Institute, Advocate Aurora HealthFollow
Jasbir Sra, Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke’s Medical Centers, University of Wisconsin School of Medicine and Public HealthFollow

Publication Date

7-27-2020

Keywords

atrial fibrillation, atrial flutter, catheter ablation, hybrid, surgical ablation, mitral isthmus, recurrence

Abstract

Purpose: It is It is widely accepted that atrial fibrillation (AF) accounts for half of arrhythmia recurrences following endocardial catheter ablation of AF. An epicardial-endocardial approach (hybrid) has emerged as an alternative to endocardial ablation alone for the treatment of AF, yet recurrence after a hybrid procedure has not been well characterized. This retrospective study is aimed at characterizing recurrence following hybrid ablation for patients with persistent AF.

Methods: Patients with persistent AF (N = 108) received both endocardial and epicardial ablation of the posterior left atrial wall using catheter ablation and a small midline surgical approach (hybrid). Presence of atrial flutter or AF was determined with ambulatory monitoring (n = 22) or electrocardiogram analysis (n = 86) at each follow-up visit. Recurrence mode was confirmed by electrophysiology study for those patients undergoing subsequent catheter ablation after hybrid ablation.

Results: Patients were followed for a mean ± standard deviation of 25 ± 14 months. Of patients who had a recurrence, 53% (n = 33) were in atrial flutter and 47% (n = 29) were in AF. Of those who had a recurrence with atrial flutter, 14 received repeat ablation for either left (n = 11) or left/right (n = 3) atrial flutter and 3 received AF ablation. Half of ablations for atrial flutter recurrence following the hybrid procedure involved the mitral isthmus.

Conclusions: Atrial flutter accounts for about half of arrhythmia recurrences post-hybrid ablation. If catheter ablation of the mitral isthmus is considered during the hybrid procedure to prevent subsequent occurrence of perimitral flutter, bidirectional block must be performed to ensure a complete line of block.

Recommended Citation

Kress DC, Erickson L, Mengesha TW, Krum D, Sra J. Characterizing recurrence following hybrid ablation in patients with persistent atrial fibrillation. J Patient Cent Res Rev. 2020;7:227-38. doi: 10.17294/2330-0698.1744