LONG-TERM OUTCOMES OF CONVERGENT ABLATION FOR PERSISTENT AND LONG-STANDING PERSISTENT ATRIAL FIBRILLATION

Single-stage hybrid radiofrequency ablation (hRFA) combines endoscopic epicardial and catheter endocardial ablation as a treatment for otherwise unsolvable long-term persistent atrial fibrillation (AF). We present the evaluation of outcomes at one center following hRFA.
Methods: A total of 60 patients aged 61.59 ± 7.8 years underwent single-stage hRFA from April 2016 to March 2022 at a Centre for Cardiovascular and Transplant Surgery and St. Anne’s University Hospital Brno, Czech Republic. This method includes thoracoscopic isolation of pulmonary veins and box lesion creation followed by catheter based verification of the effect of the surgical portion of the procedure in one procedure.
Baseline and follow-up data were prospectively recorded during scheduled follow-up. The primary outcome was freedom from AF on/off anti-arrhythmic drugs after a 12-month follow-up. Secondary outcomes included freedom from AF over the entire follow-up, freedom from anti-arrhythmic drugs, and freedom from any atrial arrhythmias, repeat ablation, and complications.
Results: The median duration of the procedure was 237 minutes and the median duration of hospitalization was 10 days. At the end of the procedure, 60 patients (100%) had sinus rhythm (SR). At the first follow-up after three months of surgery, 49 of 57 (85.9%) patients were AF-free, at the 6-month follow-up, 46 of 56 patients (82.0%) were AF-free. At the 12-month visit 41 of 55 (76.4%) patients were AF-free and at 24 months were 33 of the initial 53 patients (62,2%) event free. Seven patients were lost to follow-up. Acute complications were 1x left atrial perforation resolved successfully by suture and 1x transient ischaemic attack without permanent sequelae. Late complications involved one massive pulmonary embolization and an atrioesophageal fistula. There was no periprocedural myocardial infarction or stroke with permanent sequelae.

Conclusion: Single stage hybrid radiofrequency ablation is an effective and relatively safe mini-invasive method of treatment for long-term persistent atrial fibrillation with extremely enlarged LA.