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Heart Rhythm. 2013 Jan;10(1):22-8. doi: 10.1016/j.hrthm.2012.08.044. Epub 2012 Sep 1.

Hybrid epicardial-endocardial ablation using a pericardioscopic technique for the treatment of atrial fibrillation.

Author information

1
Division of Cardiology, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7075, USA. anilgehi@med.unc.edu

Abstract

BACKGROUND:

Catheter ablation is an effective treatment for medically refractory, disabling atrial fibrillation (AF). Ablation success may be limited in patients with persistent or long-standing persistent AF. A pericardioscopic, hybrid epicardial-endocardial technique for AF ablation may be a preferred approach for such patients. Limited data are available using such an approach.

OBJECTIVE:

To evaluate 1-year outcomes of a hybrid technique for AF ablation.

METHODS:

A cohort of 101 patients underwent AF ablation using a transdiaphragmatic pericardioscopic, hybrid epicardial-endocardial technique. Patients were followed with 24-hour Holter monitors at 3-, 6-, and 12-month intervals. Symptom severity was assessed at baseline and follow-up by using the Canadian Cardiovascular Society Severity of Atrial Fibrillation scale.

RESULTS:

Mean AF duration was 5.9 years; 47% were persistent and 37% were long-standing persistent. Mean left atrial size was 5.1 cm (range 3.3-7 cm). Overall, 12-month arrhythmia-free survival was 66.3% after a single ablation procedure and 70.5% including repeat ablation. Repeat ablation was required in 6% of the patients and antiarrhythmic drug therapy in 37% of the patients. Quality of life improved significantly and was durable over 12-month follow-up. There were 2 deaths, which occurred in the early postoperative period: one due to atrioesophageal fistula and the second due to sudden cardiac death without apparent cause by autopsy.

CONCLUSIONS:

We report the largest series to date of a hybrid epicardial-endocardial, stand-alone ablation procedure using a pericardioscopic technique for the treatment of AF. While respecting the identified complications, our results demonstrate a high potential for successful treatment in a challenging patient population with AF.

PMID:
23064043
DOI:
10.1016/j.hrthm.2012.08.044
[Indexed for MEDLINE]
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