Hybrid Catheter Plus Surgical Ablation for AF: A Meta-Analysis

The joint execution of catheter and surgical ablation procedures is a nascent strategy in the treatment of patients with atrial fibrillation (AF). In a meta-analysis, led by Jason Varzaly, researchers examined the hybrid ablation procedure and concluded that it yielded effective rhythm outcomes with an acceptable safety profile. The data were presented in JTCVS Open.

The systematic literature review identified a total of 22 single-center studies covering 925 patients with AF—38% with persistent and 51% with longstanding persistent. Surgical interventions of the included studies were pulmonary vein isolation (n=11) or box lesion with additional ablation (n=11), followed by either sequential (n=9), staged (n=9), or combination (n=4) catheter ablation.

Rhythm Outcomes with Hybrid Ablation Procedure

The mean follow-up of the studies was 19 months. At 19 ± 25 months (range, 6-128), sinus rhythm maintenance was 79.4% (95% CI, 72.4-85.7) with antiarrhythmic drugs and 70.7% (95% CI, 62.2-78.7) without.

The analysts determined that use of the bipolar AtriCure Synergy system plus left atrial appendage exclusion yielded the best rhythm outcomes in patients not on antiarrhythmic drugs (P≤.01). For safety, the overall rate of complications was 6.5% (95% CI, 3.4-10.2). Specific complication rates were as follows:

• Mortality: 0.2% (95% CI, 0-0.9)
• Stroke: 0.3% (95% CI, 0-1.1)
• Reoperation for bleeding: 1.6% (95% CI, 0.6-3.0)
• Permanent pacing: ~0% (95% CI, 0-0.5)
• Conversion to sternotomy: 0.3% (95% CI, 0-1.1)
• Atrioesophageal fistula: ~0% (95% CI, 0-0.5)
• Phrenic nerve injury: 0.3% (95% CI, 0-1.1)

On the impact to clinical practice, the authors wrote that “[the] early results suggest a potential role for this novel strategy in selected patients with AF, given the suboptimal results of catheter-based approach in those with a more persistent form of the arrhythmia.”

Ultimately, Varzaly and colleagues determined that the hybrid ablation procedure yielded favorable outcomes and had a safety profile comparable to early catheter ablation strategies.

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