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. 2022 Sep 23:9:881831.
doi: 10.3389/fcvm.2022.881831. eCollection 2022.

Catheter ablation and thoracoscopic ablation in long persistent atrial fibrillation with large left atrium

Chan Soon Park  1 , Eue-Keun Choi  1   2 , So-Ryoung Lee  1 , Hyo-Jeong Ahn  1 , Soonil Kwon  1 , Sunhwa Kim  1 , Suk Ho Sohn  3 , Jae Woong Choi  3   4 , Ho Young Hwang  3   4 , Seil Oh  1   2
Affiliations

Catheter ablation and thoracoscopic ablation in long persistent atrial fibrillation with large left atrium

Chan Soon Park et al. Front Cardiovasc Med. .

Abstract

Background: Pulmonary vein antrum isolation (PVAI) is the cornerstone of atrial fibrillation (AF) ablation, but the clinical outcomes of PVAI are unsatisfactory in patients with persistent AF and a large left atrium (LA).

Objectives: We investigated the clinical outcomes following radiofrequency ablation (RFCA), cryoballoon ablation (CBA), and thoracoscopic maze in patients with persistent AF and a large LA.

Methods: We included patients with consecutive persistent AF who had a large LA (LA diameter >50 mm) and underwent RFCA, CBA, or thoracoscopic maze surgery. In the RFCA group, additional linear ablation was performed at the physician's discretion. The endpoint was 12 months without recurrence of an atrial arrhythmia, including AF, atrial flutter, and atrial tachycardia, following a 90-day blanking period.

Results: We recruited 89 persistent AF patients with a large LA who underwent RFCA (n = 32), CBA (n = 38), or the thoracoscopic maze procedure (n = 19). During the 12-month follow-up, 48 (53.9%) cases of AF recurrence were observed. There was no prognostic difference between groups (50.0% in RFCA vs. 52.6% in CBA vs. 63.2% in thoracoscopic maze, all P > 0.05). Early recurrence during the blanking period was a significant predictor of late recurrence for RFCA and CBA, but not for the thoracoscopic maze.

Conclusion: In persistent AF patients with a large LA, we did not find a prognostic difference RFCA, CBA, or a thoracoscopic maze procedure in recurrence of atrial arrhythmia. Early recurrence predicted late recurrence in catheter ablation, but not in thoracoscopic maze.

Keywords: atrial fibrillation; cryoablation; enlarged left atrium; radiofrequency catheter ablation; recurrence; thoracoscopic maze.

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Conflict of interest statement

E-KC: Research grants or speaking fees from Bayer, BMS/Pfizer, Biosense Webster, Chong Kun Dang, Daiichi-Sankyo, Dreamtech Co., Ltd., Medtronic, Samjinpharm, Sanofi-Aventis, Seers Technology, and Skylabs. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Clinical outcomes according to each treatment strategy. The Kaplan-Meier survival curves for freedom from 12-month late recurrence in patients treated with RFCA, those with CBA, and those treated with thoracoscopic maze surgery are presented. CBA, cryoballoon ablation; RFCA, radiofrequency catheter ablation.
FIGURE 2
FIGURE 2
Association between early and late recurrence. The incidence of early recurrence and late recurrence in each treatment group [(A) CBA group, (B) RFCA group, and (C) Thoracoscopic Maze group] is demonstrated. CBA, cryoballoon ablation; RFCA, radiofrequency catheter ablation.
See this image and copyright information in PMC

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