Hybrid Procedure (Endo/Epicardial) versus Standard Manual Ablation in Patients Undergoing Ablation of Longstanding Persistent Atrial Fibrillation

Results from a Single Center

Zachary Edgerton, Alessandro Paoletti Perini, Rodney Horton, Chintan Trivedi, Pasquale Santangeli, Rong Bai, Carola Gianni, Sanghamitra Mohanty, J. David Burkhardt, G. Joseph Gallinghouse, Javier E. Sanchez, Shane Bailey, Maegen Lane, Luigi Di Biase, Francesco Santoro, Justin Price, Andrea Natale

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Hybrid versus Endocardial Ablation for LSPAF: Introduction: Ablation of longstanding persistent atrial fibrillation (LSPAF) is the most challenging procedure in the treatment of AF, either by surgical or by percutaneous approach. Objective: We investigated the difference in success and complication rates between combined surgical epicardial and endocardial catheter ablation procedure and our standard endocardial ablation procedure. Methods and Results: Twenty-four consecutive patients (group 1) with LSPAF and enlarged left atrium (>4.5 cm) underwent a combined procedure, consisting of surgical, closed-chest, epicardial, radiofrequency ablation (nContact, NC, USA) via pericardial access, and concomitant endocardial ablation (hybrid procedure). Procedural complications and long-term outcomes were compared to those of 35 consecutive patients who refused the hybrid procedure and underwent standard endocardial only ablation (group 2). Baseline characteristics were comparable. In group 1, 1 patient (4.2%) developed post-procedural cardio-embolic stroke and 3 (12.5%) died (1 atrio-esophageal fistula, 1 fatal stroke, 1 of unknown cause in early follow-up), while no strokes or deaths occurred in group 2. Overall complication rates were higher for group 1 (P = 0.036). At 24-month follow-up, 4 (19%) patients in group 1 and 19 (54.3%) in group 2 were arrhythmia-free after a single procedure, on or off antiarrhythmic drugs (P

Original languageEnglish (US)
JournalJournal of Cardiovascular Electrophysiology
DOIs
StateAccepted/In press - 2016

Fingerprint

Atrial Fibrillation
Stroke
Esophageal Fistula
Catheter Ablation
Anti-Arrhythmia Agents
Heart Atria
Cardiac Arrhythmias
Thorax

Keywords

  • Atrial fibrillation
  • Catheter ablation
  • Endocardial approach
  • Hybrid procedure
  • Longstanding persistent atrial fibrillation
  • Surgery
  • Unipolar surgical ablation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Hybrid Procedure (Endo/Epicardial) versus Standard Manual Ablation in Patients Undergoing Ablation of Longstanding Persistent Atrial Fibrillation : Results from a Single Center. / Edgerton, Zachary; Perini, Alessandro Paoletti; Horton, Rodney; Trivedi, Chintan; Santangeli, Pasquale; Bai, Rong; Gianni, Carola; Mohanty, Sanghamitra; Burkhardt, J. David; Gallinghouse, G. Joseph; Sanchez, Javier E.; Bailey, Shane; Lane, Maegen; Di Biase, Luigi; Santoro, Francesco; Price, Justin; Natale, Andrea.

In: Journal of Cardiovascular Electrophysiology, 2016.

Research output: Contribution to journalArticle

Edgerton, Z, Perini, AP, Horton, R, Trivedi, C, Santangeli, P, Bai, R, Gianni, C, Mohanty, S, Burkhardt, JD, Gallinghouse, GJ, Sanchez, JE, Bailey, S, Lane, M, Di Biase, L, Santoro, F, Price, J & Natale, A 2016, 'Hybrid Procedure (Endo/Epicardial) versus Standard Manual Ablation in Patients Undergoing Ablation of Longstanding Persistent Atrial Fibrillation: Results from a Single Center', Journal of Cardiovascular Electrophysiology. https://doi.org/10.1111/jce.12926
Edgerton, Zachary ; Perini, Alessandro Paoletti ; Horton, Rodney ; Trivedi, Chintan ; Santangeli, Pasquale ; Bai, Rong ; Gianni, Carola ; Mohanty, Sanghamitra ; Burkhardt, J. David ; Gallinghouse, G. Joseph ; Sanchez, Javier E. ; Bailey, Shane ; Lane, Maegen ; Di Biase, Luigi ; Santoro, Francesco ; Price, Justin ; Natale, Andrea. / Hybrid Procedure (Endo/Epicardial) versus Standard Manual Ablation in Patients Undergoing Ablation of Longstanding Persistent Atrial Fibrillation : Results from a Single Center. In: Journal of Cardiovascular Electrophysiology. 2016.
@article{f3f6d506d17746feb0cf75e5e6b72e24,
title = "Hybrid Procedure (Endo/Epicardial) versus Standard Manual Ablation in Patients Undergoing Ablation of Longstanding Persistent Atrial Fibrillation: Results from a Single Center",
abstract = "Hybrid versus Endocardial Ablation for LSPAF: Introduction: Ablation of longstanding persistent atrial fibrillation (LSPAF) is the most challenging procedure in the treatment of AF, either by surgical or by percutaneous approach. Objective: We investigated the difference in success and complication rates between combined surgical epicardial and endocardial catheter ablation procedure and our standard endocardial ablation procedure. Methods and Results: Twenty-four consecutive patients (group 1) with LSPAF and enlarged left atrium (>4.5 cm) underwent a combined procedure, consisting of surgical, closed-chest, epicardial, radiofrequency ablation (nContact, NC, USA) via pericardial access, and concomitant endocardial ablation (hybrid procedure). Procedural complications and long-term outcomes were compared to those of 35 consecutive patients who refused the hybrid procedure and underwent standard endocardial only ablation (group 2). Baseline characteristics were comparable. In group 1, 1 patient (4.2{\%}) developed post-procedural cardio-embolic stroke and 3 (12.5{\%}) died (1 atrio-esophageal fistula, 1 fatal stroke, 1 of unknown cause in early follow-up), while no strokes or deaths occurred in group 2. Overall complication rates were higher for group 1 (P = 0.036). At 24-month follow-up, 4 (19{\%}) patients in group 1 and 19 (54.3{\%}) in group 2 were arrhythmia-free after a single procedure, on or off antiarrhythmic drugs (P",
keywords = "Atrial fibrillation, Catheter ablation, Endocardial approach, Hybrid procedure, Longstanding persistent atrial fibrillation, Surgery, Unipolar surgical ablation",
author = "Zachary Edgerton and Perini, {Alessandro Paoletti} and Rodney Horton and Chintan Trivedi and Pasquale Santangeli and Rong Bai and Carola Gianni and Sanghamitra Mohanty and Burkhardt, {J. David} and Gallinghouse, {G. Joseph} and Sanchez, {Javier E.} and Shane Bailey and Maegen Lane and {Di Biase}, Luigi and Francesco Santoro and Justin Price and Andrea Natale",
year = "2016",
doi = "10.1111/jce.12926",
language = "English (US)",
journal = "Journal of Cardiovascular Electrophysiology",
issn = "1045-3873",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Hybrid Procedure (Endo/Epicardial) versus Standard Manual Ablation in Patients Undergoing Ablation of Longstanding Persistent Atrial Fibrillation

T2 - Results from a Single Center

AU - Edgerton, Zachary

AU - Perini, Alessandro Paoletti

AU - Horton, Rodney

AU - Trivedi, Chintan

AU - Santangeli, Pasquale

AU - Bai, Rong

AU - Gianni, Carola

AU - Mohanty, Sanghamitra

AU - Burkhardt, J. David

AU - Gallinghouse, G. Joseph

AU - Sanchez, Javier E.

AU - Bailey, Shane

AU - Lane, Maegen

AU - Di Biase, Luigi

AU - Santoro, Francesco

AU - Price, Justin

AU - Natale, Andrea

PY - 2016

Y1 - 2016

N2 - Hybrid versus Endocardial Ablation for LSPAF: Introduction: Ablation of longstanding persistent atrial fibrillation (LSPAF) is the most challenging procedure in the treatment of AF, either by surgical or by percutaneous approach. Objective: We investigated the difference in success and complication rates between combined surgical epicardial and endocardial catheter ablation procedure and our standard endocardial ablation procedure. Methods and Results: Twenty-four consecutive patients (group 1) with LSPAF and enlarged left atrium (>4.5 cm) underwent a combined procedure, consisting of surgical, closed-chest, epicardial, radiofrequency ablation (nContact, NC, USA) via pericardial access, and concomitant endocardial ablation (hybrid procedure). Procedural complications and long-term outcomes were compared to those of 35 consecutive patients who refused the hybrid procedure and underwent standard endocardial only ablation (group 2). Baseline characteristics were comparable. In group 1, 1 patient (4.2%) developed post-procedural cardio-embolic stroke and 3 (12.5%) died (1 atrio-esophageal fistula, 1 fatal stroke, 1 of unknown cause in early follow-up), while no strokes or deaths occurred in group 2. Overall complication rates were higher for group 1 (P = 0.036). At 24-month follow-up, 4 (19%) patients in group 1 and 19 (54.3%) in group 2 were arrhythmia-free after a single procedure, on or off antiarrhythmic drugs (P

AB - Hybrid versus Endocardial Ablation for LSPAF: Introduction: Ablation of longstanding persistent atrial fibrillation (LSPAF) is the most challenging procedure in the treatment of AF, either by surgical or by percutaneous approach. Objective: We investigated the difference in success and complication rates between combined surgical epicardial and endocardial catheter ablation procedure and our standard endocardial ablation procedure. Methods and Results: Twenty-four consecutive patients (group 1) with LSPAF and enlarged left atrium (>4.5 cm) underwent a combined procedure, consisting of surgical, closed-chest, epicardial, radiofrequency ablation (nContact, NC, USA) via pericardial access, and concomitant endocardial ablation (hybrid procedure). Procedural complications and long-term outcomes were compared to those of 35 consecutive patients who refused the hybrid procedure and underwent standard endocardial only ablation (group 2). Baseline characteristics were comparable. In group 1, 1 patient (4.2%) developed post-procedural cardio-embolic stroke and 3 (12.5%) died (1 atrio-esophageal fistula, 1 fatal stroke, 1 of unknown cause in early follow-up), while no strokes or deaths occurred in group 2. Overall complication rates were higher for group 1 (P = 0.036). At 24-month follow-up, 4 (19%) patients in group 1 and 19 (54.3%) in group 2 were arrhythmia-free after a single procedure, on or off antiarrhythmic drugs (P

KW - Atrial fibrillation

KW - Catheter ablation

KW - Endocardial approach

KW - Hybrid procedure

KW - Longstanding persistent atrial fibrillation

KW - Surgery

KW - Unipolar surgical ablation

UR - http://www.scopus.com/inward/record.url?scp=84959449530&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84959449530&partnerID=8YFLogxK

U2 - 10.1111/jce.12926

DO - 10.1111/jce.12926

M3 - Article

JO - Journal of Cardiovascular Electrophysiology

JF - Journal of Cardiovascular Electrophysiology

SN - 1045-3873

ER -