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

作者：Gehi Anil K^*; Mounsey J Paul; Purse Irion; Landers Mark; Boyce Ker; Chung Eugene H; Schwartz Jennifer; Walker T Jennifer; Guise Kimberly; Kiser Andy C

来源：Heart Rhythm, 2013, 10(1): 22-28.

DOI：10.1016/j.hrthm.2012.08.044

• Atrial fibrillation
• Catheter ablation
• Surgical ablation
• Outcomes
• Persistent atrial fibrillation
• Quality of life

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 epicardiakendocardial 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 scare.
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 singe 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 epicardiakendocardial, stand-atone 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.

• 出版日期2013-1