title: Failure of hybrid therapy for the prevention of long-term recurrence of atrial fibrillation.
abstract: OBJECTIVE
  To determine the long-term effectiveness of hybrid therapy in the control of atrial fibrillation (AF) as well as the differences in clinical outcomes between patients with antiarrhythmic drug atrial flutter (AAD-AFl), those with coexistent AFl and AF, and isolated AFl.
  
  
  METHODS
  Four hundred eight patients who consecutively underwent cavotricuspid isthmus (CTI) ablation between 1998 and 2010 were followed for 5.9 years. Twenty-seven patients had AAD-AF1 (Group 1): they had AF but not AFl at baseline but on AAD therapy they showed typical AFl. They underwent CTI ablation and continued with AAD therapy, 96 patients had coexistent AF1 and AF at baseline (Group 2) and continued with AAD therapy at the discretion of their cardiologists and 284 patients had isolated AFl (Group 3).
  
  
  RESULTS
  AF recurred in the majority of the AAD-AF1 patients (74%, incident density rate (IDR): 19.1/100 person-years). This incidence rate was similar to the recurrence rate of AF in patients with coexistent AFl and AF (59%, IDR: 19.2/100 person-years). The patients in Group 1 had a similar IDR of stroke as Group 2 and a slightly higher rate than Group 3. There were no significant differences in the IDR for death among Groups 1, 2 and 3.
  
  
  CONCLUSIONS
  Hybrid therapy was not effective for long-term control of AF. The clinical outcomes (AF, stroke and death) were similar for AAD-AF1 patients and patients with coexistent AF and AFl.
authors.affiliation: Cardiology Department, Arrhythmia Unit, Clinical University Hospital of Santiago de Compostela, Spain. Electronic address: javiergarciaseara@yahoo.es.
authors.forename: Javier
authors.initials: J
authors.lastname: García Seara
authors.affiliation: Cardiology Department, Arrhythmia Unit, Clinical University Hospital of Santiago de Compostela, Spain.
authors.forename: Sergio
authors.initials: S
authors.lastname: Raposeiras Roubin
authors.affiliation: Epidemiology Department, Arrhythmia Unit, Clinical University Hospital of Santiago de Compostela, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Gude Sampedro
authors.affiliation: Epidemiology Department, Arrhythmia Unit, Clinical University Hospital of Santiago de Compostela, Spain.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Balboa Barreiro
authors.affiliation: Cardiology Department, Arrhythmia Unit, Clinical University Hospital of Santiago de Compostela, Spain.
authors.forename: Jose L
authors.initials: JL
authors.lastname: Martínez Sande
authors.affiliation: Cardiology Department, Arrhythmia Unit, Clinical University Hospital of Santiago de Compostela, Spain.
authors.forename: Moisés
authors.initials: M
authors.lastname: Rodríguez Mañero
authors.affiliation: Cardiology Department, Arrhythmia Unit, Clinical University Hospital of Santiago de Compostela, Spain.
authors.forename: José Ramón
authors.initials: JR
authors.lastname: González Juanatey
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage*; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000401:mortality / Q000517:prevention & control*; D017115:Catheter Ablation; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015996:Survival Rate / Q000639:trends; D017211:Treatment Failure; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: Atrial fibrillation; Atrial flutter; Cavotricuspid isthmus ablation; Hybrid therapy; Stroke