title: Minimally invasive hybrid ablation procedure for the treatment of persistent atrial fibrillation: one year results.
abstract: BACKGROUND
  The concept of a hybrid approach, combining the most effective techniques of surgical and endocardial catheter ablation has resulted in the creation of the convergent ablation procedure. This novel, pericardioscopic, hybrid approach can be an effective option for highly symptomatic patients with persistent atrial fibrillation (PSAF) and longstanding persistent atrial fibrillation (LSPAF) for whom standalone surgical or endocardial ablation procedures offer sometimes unsatisfactory outcomes.
  
  
  OBJECTIVE
  To assess the safety, efficacy and effectiveness of a hybrid epicardial and endocardial radiofrequency ablation for the treatment of PSAF and LSPAF.
  
  
  METHODS
  Single-centre, prospective, non-randomised clinical study. Between August 2009 and December 2011, 27 patients with PSAF (n = 5) and LSPAF (n = 22) underwent hybrid ablation (HABL). Mean age was 52.52 ± 11.27 years, and the mean EHRA class was 2.5; 14 (51.8%) patients had a history of electrical cardioversion (n = 6) or catheter ablation (n = 8). Five patients had left ventricular ejection fraction (LVEF) of less than 35%. Mean AF duration for all patients was 3.46 ± 2.5 years. All patients were on antiarrhythmic drugs (AAD) and oral anticoagulation. Patients were scheduled for three, six and 12 month follow-up with seven day Holters, REVEAL® XT and ECHO measurements.
  
  
  RESULTS
  The HABL procedure was feasible in all patients. At six months post procedure, 72.2% (13/18) of patients were in SR, and 66.5% (12/18) were off class I/III AADs. Four patients were in AF and one patient developed right atrial flutter. At one year post procedure, 80% (8/10) of patients were in SR and off class I/III AADs. At two year post procedure, 100% (6/6) of patients were in SR and off class I/III AADs. Rapid change in left ventricular function was noted in patients with low LVEF (≤ 35%) prior to the procedure. Patients with LVEF +40% had less apparent improvement.
  
  
  CONCLUSIONS
  Hybrid, epicardial and endocardial, radiofrequency ablation is feasible and safe, effectively restoring sinus rhythm in the vast majority of patients with PSAF and LSPAF.
authors.affiliation: Department of Cardiac Surgery and Transplantology, Silesian Centre For Heart Diseases, Zabrze, Poland. m.zembala.jr@sccs.pl
authors.forename: Michał
authors.initials: M
authors.lastname: Zembala
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Filipiak
authors.forename: Oskar
authors.initials: O
authors.lastname: Kowalski
authors.forename: Joanna
authors.initials: J
authors.lastname: Boidol
authors.forename: Adam
authors.initials: A
authors.lastname: Sokal
authors.forename: Radosław
authors.initials: R
authors.lastname: Lenarczyk
authors.forename: Tomasz
authors.initials: T
authors.lastname: Niklewski
authors.forename: Marcin
authors.initials: M
authors.lastname: Garbacz
authors.forename: Paweł
authors.initials: P
authors.lastname: Nadziakiewicz
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Kalarus
authors.forename: Marian
authors.initials: M
authors.lastname: Zembala
mesh_terms: D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D002305:Cardiac Tamponade / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D017115:Catheter Ablation / Q000009:adverse effects* / Q000379:methods; D004452:Echocardiography; D015716:Electrocardiography, Ambulatory; D004939:Esophageal Perforation / Q000175:diagnosis / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D022125:Lacerations / Q000209:etiology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects* / Q000379:methods*; D011182:Postoperative Care; D011446:Prospective Studies; D016896:Treatment Outcome; D014682:Vena Cava, Inferior / Q000293:injuries