Simultaneous hybrid maze procedure for long-standing persistent atrial fibrillation with dilated atrium

Zhe Zheng; Yan Yao; Haojie Li; Lihui Zheng; Sheng Liu; Hengqiang Lin; Fujian Duan

doi:10.1016/j.xjtc.2020.10.015

Simultaneous hybrid maze procedure for long-standing persistent atrial fibrillation with dilated atrium

JTCVS Tech. 2020 Oct 27:5:34-42. doi: 10.1016/j.xjtc.2020.10.015. eCollection 2021 Feb.

Authors

Zhe Zheng^{1

2}, Yan Yao^{1

3}, Haojie Li^{1

2}, Lihui Zheng^{1

3}, Sheng Liu^{1

2}, Hengqiang Lin^{1

2}, Fujian Duan^{1

4}

Affiliations

¹ National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
² Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
³ Department of Arrhythmia, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
⁴ Department of Medical Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.

Abstract

Background: The efficacy of catheter-based or thoracoscopic ablation for treating long-standing persistent atrial fibrillation (AF) with a dilated atrium remains suboptimal. This study aimed to assess the feasibility and initial results of simultaneous hybrid ablation with a new biatrial lesion set in these patients.

Methods: Twenty-seven consecutive patients with long-standing persistent AF and dilated atrium underwent simultaneous hybrid ablation with a new biatrial lesion set consistent with the principle of the Cox maze procedure at our institution. Patients were followed up at 3, 6, and 12 months after the procedure and annually thereafter.

Results: After thoracoscopic epicardial ablation, endocardial mapping confirmed complete bilateral pulmonary vein isolation in 25 patients (96.2%). All patients were followed for a mean of 18.7 ± 8.9 months. Freedom from atrial tachyarrhythmia at 1 year after the single hybrid procedure was 64% with antiarrhythmic drugs and 60% without antiarrhythmic drugs. Freedom from atrial tachyarrhythmia at latest follow-up after the hybrid procedure and redo catheter ablation was 77.8% with antiarrhythmic drugs and 74.1% without antiarrhythmic drugs. In patients with sinus rhythm restoration, mean left atrial diameter decreased from 54.4 ± 4.3 mm to 45.2 ± 4.1 mm (P < .001), and mean right atrial diameter decreased from 59.4 ± 3.9 mm to 54.9 ± 4.4 mm (P < .001). Postoperative pleural effusion was observed in 3 patients (11.1%), and no adverse events occurred during follow-up.

Conclusions: In patients with long-standing persistent AF and a dilated atrium, simultaneous hybrid ablation with the new biatrial lesion set, in combination with touch-up catheter ablation when necessary, can achieve promising results. More studies are needed to confirm these findings.

Keywords: AAD, antiarrhythmic drug; AF, atrial fibrillation; AFL, atrial flutter; CA, catheter ablation; ECG, electrocardiography; IVC, inferior vena cava; LA, left atrium; LAA, left atrial appendage; LAD, left atrial diameter; LSPAF, long-standing persistent atrial fibrillation; NT-proBNP, N-terminal pro B-type natriuretic peptide; PV, pulmonary vein; RA, right atrium; RAD, right atrial diameter; SR, sinus rhythm; SVC, superior vena cava; dilated atrium; hybrid ablation; long-standing persistent atrial fibrillation; maze.