Hybrid Biatrial Ablation Versus Catheter Ablation for Patients With Nonparoxysmal Atrial Fibrillation and Enlarged Left Atrium.

IF 1.6 Q2 SURGERY Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery Pub Date : 2024-09-21 DOI:10.1177/15569845241275161

Chunyu Yu, Haojie Li, Zhiwei Zeng, Lihui Zheng, Lingmin Wu, Ligang Ding, Yan Yao, Zhe Zheng

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Abstract

Objective: There is no consensus on the optimal ablation strategy for nonparoxysmal atrial fibrillation (NPAF) with enlarged left atrium. We aimed to explore whether hybrid ablation (HA) of combined thoracoscopic surgical ablation with catheter ablation (CA) was superior to CA alone in these patients.

Methods: Patients with NPAF and left atrial diameter (LAD) ≥45 mm who underwent hybrid biatrial ablation or CA procedure from June 2014 to July 2021 were included in this study. Propensity score matching was applied to select patients in each group. The primary endpoint was freedom from atrial tachyarrhythmias after procedures.

Results: After propensity score matching, 52 patients with enlarged left atrium (median LAD = 51 mm) were enrolled in each group. The median follow-up was 36 months. The probability of freedom from atrial tachyarrhythmias at 12, 24, and 36 months on antiarrhythmic drugs (AADs) was 70.1%, 65.4%, and 62.6% in the HA group and 34.3%, 29.4%, and 22.0% in the CA group, respectively (P < 0.001); off AADs was 57.1%, 52.7%, and 50.0% in the HA group and 25.0%, 16.2%, and 11.5% in the CA group (P < 0.001); on AADs after redo CA was 76.2%, 73.7%, and 73.7% in the HA group and 43.6%, 43.6%, and 38.2% in the CA group, respectively (P < 0.001); off AADs after redo CA was 62.5%, 60.1%, and 60.1% in the HA group and 30.4%, 25.1%, and 20.9% in the CA group, respectively (P < 0.001).

Conclusions: For patients with NPAF and enlarged left atrium, hybrid biatrial ablation was superior to CA in sinus rhythm maintenance even if redo CA was performed.

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非阵发性心房颤动和左心房扩大患者的混合生物心房消融术与导管消融术。

目的：对于左心房扩大的非阵发性心房颤动（NPAF）的最佳消融策略尚未达成共识。我们的目的是探讨在这些患者中，胸腔镜手术消融与导管消融相结合的混合消融术（HA）是否优于单独的导管消融术：本研究纳入了2014年6月至2021年7月期间接受混合双心房消融术或导管消融术的NPAF且左心房直径（LAD）≥45 mm的患者。每组患者均采用倾向评分匹配法进行筛选。主要终点是术后无房性快速性心律失常：经过倾向评分匹配，每组共纳入 52 名左心房扩大（中位 LAD = 51 mm）患者。中位随访时间为 36 个月。服用抗心律失常药物（AADs）12、24和36个月时，HA组患者不再发生房性快速性心律失常的概率分别为70.1%、65.4%和62.6%，CA组患者分别为34.3%、29.4%和22.0%（P < 0.001）；HA组患者不再服用AADs的概率分别为57.1%、52.7%和50.0%，CA组患者分别为25.0%、16.2%和11.5%（P < 0.001）。5%（P＜0.001）；重做CA后，HA组的AAD开启率分别为76.2%、73.7%和73.7%，CA组分别为43.6%、43.6%和38.2%（P＜0.001）；重做CA后，HA组的AAD关闭率分别为62.5%、60.1%和60.1%，CA组分别为30.4%、25.1%和20.9%（P＜0.001）：结论：对于 NPAF 和左心房扩大的患者，即使进行了重做 CA，杂交双腔消融术在维持窦性心律方面仍优于 CA。

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来源期刊

Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery SURGERY-

CiteScore

2.00

自引率

6.70%

发文量

期刊介绍： Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery is the first journal whose main mission is to disseminate information specifically about advances in technology and techniques that lead to less invasive treatment of cardiothoracic and vascular disease. It delivers cutting edge original research, reviews, essays, case reports, and editorials from the pioneers and experts in the field of minimally invasive cardiothoracic and vascular disease, including biomedical engineers. Also included are papers presented at the annual ISMICS meeting. Official Journal of the International Society for Minimally Invasive Cardiothoracic Surgery