title: Staged hybrid ablation for persistent and longstanding persistent atrial fibrillation effectively restores sinus rhythm in long-term observation.
abstract: BACKGROUND
  Hybrid ablation (HABL) of atrial fibrillation combining endoscopic, minimally invasive, closed chest epicardial ablation with endocardial CARTO-guided accuracy was introduced to overcome the limitations of current therapeutic options for patients with persistent (PSAF) and longstanding persistent atrial fibrillation (LSPAF). The purpose of this study was to evaluate the procedural safety and feasibility as well as effectiveness of HABL in patients with PSAF and LSPAF 1 year after the procedure.
  
  
  METHODS
  The study is a single-center, prospective clinical registry. From 07/2009 to 12.2014, 90 patients with PSAF (n= 39) and LSPAF (n= 51), at the mean age of 54.8 ±9.8, in mean EHRA class 2.6, underwent HABL. 64.4% of patients had a history of prior cardioversion or catheter ablation. Thirteen patients had LVEF less than 35%. Mean AF duration was 4.5 ±3.7 years. Patients were scheduled for 3-, 6- and 12-month follow-up with 7-day Holter monitoring.
  
  
  RESULTS
  At 6 months after the procedure 78% (54/69) of patients were in SR. At 12 months after the procedure 86% (59/69) were in SR and 62.3% (43/69) in SR and off class I/III antiarrhythmic drugs (AADs). Only 1% (1/69) of patients required a repeat ablation for atrial flutter. A significant decrease in LA dimension and an increase in LVEF were noted.
  
  
  CONCLUSIONS
  A combination of epicardial and endocardial RF ablation should be considered as a treatment option for patients with persistent and long-standing persistent atrial fibrillation as it is safe and effective in restoring sinus rhythm.
authors.affiliation: Department of Cardiac Surgery and Transplantology, Silesian Center For Heart Diseases, Zabrze, Poland.
authors.forename: Michal
authors.initials: M
authors.lastname: Zembala
authors.affiliation: Department of Cardiac Surgery and Transplantology, Silesian Center For Heart Diseases, Zabrze, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Filipiak
authors.affiliation: Department of Cardiac Surgery and Transplantology, Silesian Center For Heart Diseases, Zabrze, Poland.
authors.forename: Oskar
authors.initials: O
authors.lastname: Kowalski
authors.affiliation: Department of Cardiac Surgery and Transplantology, Silesian Center For Heart Diseases, Zabrze, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Buchta
authors.affiliation: Department of Cardiac Surgery and Transplantology, Silesian Center For Heart Diseases, Zabrze, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Niklewski
authors.affiliation: Department of Cardiac Surgery and Transplantology, Silesian Center For Heart Diseases, Zabrze, Poland.
authors.forename: Pawel
authors.initials: P
authors.lastname: Nadziakiewicz
authors.affiliation: Department of Cardiac Surgery and Transplantology, Silesian Center For Heart Diseases, Zabrze, Poland.
authors.forename: Rafał
authors.initials: R
authors.lastname: Koba
authors.affiliation: Department of Cardiac Surgery and Transplantology, Silesian Center For Heart Diseases, Zabrze, Poland.
authors.forename: Mariusz
authors.initials: M
authors.lastname: Gąsior
authors.affiliation: Department of Cardiac Surgery and Transplantology, Silesian Center For Heart Diseases, Zabrze, Poland.
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Kalarus
authors.affiliation: Department of Cardiac Surgery and Transplantology, Silesian Center For Heart Diseases, Zabrze, Poland.
authors.forename: Marian
authors.initials: M
authors.lastname: Zembala
keywords: ablation; atrial fibrillation; hybrid procedures; pulmonary vein isolation