NEW YORK (Reuters Health) – Ablation of atrial fibrillation by combining the transvenous catheter approach with the thoracoscopic epicardial approach in a single procedure has a high success rate and is safe, according to a report from a Dutch team.

“Recurrent arrhythmias can be handled with AADs [antiarrhythmic drugs] or CA [catheter ablation],” Dr. Laurent Pison, at Maastricht University Medical Center and Cardiovascular Research Institute, and colleagues note in their paper in the July 3 issue of the Journal of the American College of Cardiology.

They explain that catheter ablation of paroxysmal AF is effective in more than 80% of cases, and persistent AF can often be dealt with thoracoscopically by pulmonary vein isolation and creating linear lesions. However, multiple procedures are often necessary and some linear lesions cannot be created solely from the epicardium.

“Combining a transvenous endocardial and thoracoscopic epicardial approach in a single procedure overcomes these shortcomings,” the team states.

To evaluate the safety and 1-year outcomes of this strategy, they followed 26 patients with AF (42% with persistent AF) for a mean of 470 days after they underwent the hybrid procedure.

The success rate of the single procedure — meaning sinus rhythm without use of antiarrhythmic drugs or the need for a re-do procedure — was 79% at 1 year among the patients with paroxysmal AF and 90% for those with persistent AF. This translated to an overall 1-year success rate of 83%.

Regarding safety, there were no deaths or need to convert to cardiopulmonary bypass, and no instances of phrenic nerve paralysis, according to the report. One patient required pleural effusion drainage 3 weeks after surgery and one patient had uncontrolled pain without infection requiring hospitalization for 13 days.

“The robustness of the hybrid approach lies in its complementary nature,” Dr. Pison and colleagues comment. However, they do point out that the longer-term impact of this ablation strategy on atrial systolic function remains unknown.

The author of an accompanying editorial asks if hybrid thoracoscopic and transvenous catheter ablation of AF “is the answer we are searching for?” Dr. Hugh Calkins of Johns Hopkins Hospital in Baltimore, Maryland, makes a cautionary response. “In my opinion,” he writes, “the answer is ‘not yet,’ and certainly not on the basis of the very limited worldwide experience with this approach.”


Hybrid Thoracoscopic Surgical and Transvenous Catheter Ablation of Atrial Fibrillation

J Am Coll Cardiol 2012;60:54-61.