title: Repeat Procedures After Hybrid Thoracoscopic Ablation in the Setting of Longstanding Persistent Atrial Fibrillation: Electrophysiological Findings and 2-Year Clinical Outcome.
abstract: BACKGROUND
  In order to increase success rates of invasive treatment of persistent atrial fibrillation, the hybrid approach was developed, combining video-assisted thoracoscopic epicardial procedure with conventional endocardial catheter ablation. Currently, there are no reports of electrophysiological findings and clinical outcomes of repeat procedures after the hybrid approach.
  
  
  RESULTS
  Out of 64 patients who were treated by hybrid ablation for persistent atrial fibrillation (AF), 14 underwent the repeat catheter ablation and were selected for this study. All 14 patients initially presented with longstanding persistent atrial fibrillation and markedly dilated atria. The hybrid procedure was performed in a single act and the mean time to redo procedure was 346 ± 227 days. In 57% of patients indication for redo procedure was regular atrial tachycardia, and the rest presented with recurrent atrial fibrillation. In 36% of patients, recovered conduction was found along the previous ablation lesions. Only 9% of pulmonary veins were reconnected (0.36 veins per patient) and 7% of box lesions were not complete. The overall success rate at 2 years follow-up after the repeat procedure, including second repeat procedure and patients taking antiarrhythmic drugs, was 64% (57% without drugs and further ablation). One case of moderate pulmonary vein stenosis was detected as a consequence of hybrid procedure.
  
  
  CONCLUSIONS
  Hybrid atrial fibrillation ablation results in durable lesions and high rates of chronic pulmonary vein isolation even after long-term follow-up. Most of the repeat procedures after the hybrid approach are related to left atrial flutters that could be successfully treated by catheter ablation.
authors.affiliation: Heart Rhythm Management Centre, UZ Brussels-VUB, Brussels, Belgium.
authors.forename: Vedran
authors.initials: V
authors.lastname: Velagic
authors.affiliation: Heart Rhythm Management Centre, UZ Brussels-VUB, Brussels, Belgium.
authors.forename: Carlo
authors.initials: C
authors.lastname: DE Asmundis
authors.affiliation: Heart Rhythm Management Centre, UZ Brussels-VUB, Brussels, Belgium.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Mugnai
authors.affiliation: Heart Rhythm Management Centre, UZ Brussels-VUB, Brussels, Belgium.
authors.forename: Ghazala
authors.initials: G
authors.lastname: Irfan
authors.affiliation: Heart Rhythm Management Centre, UZ Brussels-VUB, Brussels, Belgium.
authors.forename: Burak
authors.initials: B
authors.lastname: Hunuk
authors.affiliation: Heart Rhythm Management Centre, UZ Brussels-VUB, Brussels, Belgium.
authors.forename: Erwin
authors.initials: E
authors.lastname: Stroker
authors.affiliation: Heart Rhythm Management Centre, UZ Brussels-VUB, Brussels, Belgium.
authors.forename: Ebru
authors.initials: E
authors.lastname: Hacioglu
authors.affiliation: Anesthesiology Department, UZ Brussels-VUB, Brussels, Belgium.
authors.forename: Vincent
authors.initials: V
authors.lastname: Umbrain
authors.affiliation: Anesthesiology Department, UZ Brussels-VUB, Brussels, Belgium.
authors.forename: Stefan
authors.initials: S
authors.lastname: Beckers
authors.affiliation: Cardiac Surgery Department, UZ Brussels-VUB, Brussels, Belgium.
authors.forename: Jens
authors.initials: J
authors.lastname: Czapla
authors.affiliation: Cardiac Surgery Department, UZ Brussels-VUB, Brussels, Belgium.
authors.forename: Francis
authors.initials: F
authors.lastname: Wellens
authors.affiliation: Cardiac Surgery Department, UZ Brussels-VUB, Brussels, Belgium.
authors.forename: Jan
authors.initials: J
authors.lastname: Nijs
authors.affiliation: Heart Rhythm Management Centre, UZ Brussels-VUB, Brussels, Belgium.
authors.forename: Pedro
authors.initials: P
authors.lastname: Brugada
authors.affiliation: Cardiac Surgery Department, UZ Brussels-VUB, Brussels, Belgium.
authors.forename: Mark
authors.initials: M
authors.lastname: LA Meir
authors.affiliation: Heart Rhythm Management Centre, UZ Brussels-VUB, Brussels, Belgium.
authors.forename: Gian-Battista
authors.initials: GB
authors.lastname: Chierchia
mesh_terms: D000200:Action Potentials; D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001282:Atrial Flutter / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D015716:Electrocardiography, Ambulatory; D022062:Electrophysiologic Techniques, Cardiac; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013617:Tachycardia, Supraventricular / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: atrial fibrillation; hybrid procedure; left atrial flutter; pulmonary vein reconnection; radiofrequent ablation; thoracoscopic video-assisted epicardial ablation