title: Very long-term results of surgical and transcatheter ablation of long-standing persistent atrial fibrillation.
abstract: BACKGROUND
  New hybrid approaches for atrial fibrillation (AF) ablation, combining surgical and percutaneous procedures, are emerging to enhance the long-term success rate of these 2 procedures severally considered. Recent guidelines underline the need for long-term follow-up to really assess the efficacy of AF ablation.
  
  
  METHODS
  From 2000 to 2002, 33 patients with long-standing persistent AF and valvular heart disease underwent valve surgery and cryoablation (pulmonary veins isolation and mitral isthmus and roof line lesions). The surgically created ablation scheme was validated with electroanatomic mapping and percutaneous radiofrequency ablation was performed in case of lesion incompleteness.
  
  
  RESULTS
  In 19 of 33 patients (58%) the electroanatomic mapping showed a complete lesion scheme, which increased to 79% (26 of 33) with the addition of radiofrequency ablation. At the mean follow-up of 10.7 ± 3.1 years, 73% (24 of 33) of patients were in sinus rhythm (SR), whereas 27% had permanent AF. At the end of follow-up 81% of patients with a complete lesion scheme were in SR, while 43% with an incomplete one maintained SR (p = 0.048).
  
  
  CONCLUSIONS
  In patients with long-standing persistent AF and valvular heart disease, the hybrid approach with surgical cryoablation consisting of pulmonary veins isolation and left atrial linear lesions combined with transcatheter radiofrequency ablation was highly effective in maintaining SR for a very long-term follow-up. Electrophysiological evaluation, to validate the transmurality of the surgical lesions and to complete the lesion scheme applying radiofrequency energy, improved the long-term efficacy.
authors.affiliation: Department of Cardiology, School of Medicine, University of Turin, Turin, Italy. Electronic address: gaitaf@libero.it.
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita
authors.affiliation: Department of Cardiology, School of Medicine, University of Turin, Turin, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Ebrille
authors.affiliation: Department of Cardiology, Cardinal Massaia Hospital, Asti, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Scaglione
authors.affiliation: Department of Cardiology, Cardinal Massaia Hospital, Asti, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Caponi
authors.affiliation: Department of Cardiology, Cardinal Massaia Hospital, Asti, Italy.
authors.forename: Lucia
authors.initials: L
authors.lastname: Garberoglio
authors.affiliation: Department of Cardiology, Cardinal Massaia Hospital, Asti, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Vivalda
authors.affiliation: Department of Cardiac Surgery, Istituto Clinico Humanitas IRCCS, Rozzano, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Barbone
authors.affiliation: Department of Cardiac Surgery, Istituto Clinico Humanitas IRCCS, Rozzano, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Gallotti
mesh_terms: D001281:Atrial Fibrillation / Q000150:complications / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods; D017115:Catheter Ablation; D003452:Cryosurgery; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
keywords: 24; AAD; AF; CABG; EAM; EP; PVs; RF; SR; antiarrhythmic drugs; atrial fibrillation; coronary artery bypass graft; electroanatomic mapping system; electrophysiological; pulmonary veins; radiofrequency; sinus rhythm