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. 2022 Dec;37(12):4630-4638.
doi: 10.1111/jocs.17144. Epub 2022 Nov 9.

Hybrid ablation of atrial fibrillation: A unilateral left-sided thoracoscopic approach

Claudia A J van der Heijden  1   2 , Vanessa Weberndörfer  1   3 , Justin G L M Luermans  2   3 , Sevasti-Maria Chaldoupi  2   3 , Sander M J van Kuijk  4 , Mindy Vroomen  3 , Elham Bidar  1   2 , Jos G Maessen  1   2 , Laurent Pison  5 , Mark La Meir  1   6 , Bart Maesen  1   2
Affiliations

Hybrid ablation of atrial fibrillation: A unilateral left-sided thoracoscopic approach

Claudia A J van der Heijden et al. J Card Surg. 2022 Dec.

Abstract

Background: Hybrid ablation (HA) of atrial fibrillation (AF) combines minimally invasive thoracoscopic epicardial ablation with transvenous endocardial electrophysiologic validation and touch-up of incomplete epicardial lesions if needed. While studies have reported on a bilateral thoracoscopic HA approach, data on a unilateral left-sided approach are scarce.

Aim: To evaluate the efficacy and safety of a unilateral left-sided thoracoscopic approach.

Methods: Retrospective analysis of a prospectively gathered cohort of all consecutive patients undergoing a unilateral left-sided HA for AF between 2015 and 2018 in the Maastricht University Medical Centre.

Results: One-hundred nineteen patients were analyzed (mean age 64 ± 8, 28% female, mean body mass index 28 ± 4 kg/m2 , median CHA2 DS2 -VASc Score 2 [1-3], [longstanding]-persistent AF 71%, previous catheter ablation 44%). In all patients, a unilateral left-sided HA consisting of pulmonary vein (PV) isolation, posterior left atrial (LA) wall isolation, and LA appendage exclusion was attempted. Epicardial (n = 59) and/or endocardial validation (n = 81) was performed and endocardial touch-up was performed in 33 patients. Major peri-operative complications occurred in 5% of all patients. After 12 and 24 months, the probability of being free from supraventricular tachyarrhythmia recurrence was 80% [73-87] and 67% [58-76], respectively, when allowing antiarrhythmic drugs.

Conclusion: Unilateral left-sided hybrid AF ablation is an efficacious and safe approach to treat patients with paroxysmal and (longstanding) persistent AF. Future studies should compare a unilateral with a bilateral approach to determine whether a left-sided approach is as efficacious as a bilateral approach and allows for less complications.

Keywords: atrial fibrillation; hybrid ablation; unilateral left-sided approach.

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Conflict of interest statement

B. M., J. L., and M. L. M. are consultants for AtriCure and/or Medtronic.

Figures

Figure 1
Figure 1
Overview of the number of patients undergoing endocardial touch‐up per region after epicardial ablation. AF, atrial fibrillation; LSPV, left superior PV; PV, pulmonary vein; RIPV, right inferior PV; RSPV, right superior PV.
Figure 2
Figure 2
The number of unintended gaps following epicardial ablation for AF does not decrease over time. AF, atrial fibrillation.
Figure 3
Figure 3
Kaplan–Meier curve depicting the probability of being free from AF recurrence following unilateral left‐sided hybrid AF ablation until 24 months of follow‐up based on preoperative rhythm (blue, pAF; red, non‐pAF). AF, atrial fibrillation; pAF, paroxysmal AF.
See this image and copyright information in PMC

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