1-and 2-stage hybrid atrial fibrillation ablation using a biparietal irrigated radiofrequency clamp: A dual-center cohort analysis

Abstract

BACKGROUND Hybrid thoracoscopic ablation (HA), by using a bi-parietal irigated radiofrequency (RF) device for epicardial ablation combined with endocardial techniques, has emerged as a promising treatment for atrial fibrillation (AF). However, findings from the endocardial validation are lacking.<br /> OBJECTIVE This study aimed to evaluate findings of endocardial validation after epicardial isolation of the pulmonary veins (PVs) and the left atrial posterior wall (LAPW) during HA, performed either as a 1-on 2-stage procedure using a biparietal irrigated RF clamp.<br /> METHODS In this multicenter study, 57 patients with paroxysmal<br /> persistent, or long-standing persistent AF underwent 1-stage (n 28) or 2-stage HA (n = 29) , During the endocardial part, mapping was performed to assess entrance and exit blocks of the PVs and LAPW and thus evaluate lesion completeness. Periprocedural find-ings, complications, redo ablations, and clinical outcomes were eval-uated.<br /> RESULTS Patients in the 1-stage group had a longer AF duration (117 vs 33 months: P009) more long-standing persistent AF (39.3% vs 10.3%; P = 0.032 )I and fewer previous catheter ablations (39.3% vs 79.3%; P.039). Endocardial validation confirmed isolation of the PVs and LAPW in 96.4% of 1-stage and 86.2% of 2-stage procedures (P = 0.353) Complication rates were low, with no significant differences between the 2 groups. Redo catheter ablations, performed in 6 1-stage patients and 1 2-stage patient, confirmed durable PV and LAPW isolation<br /> CONCLUSION HA using an irrigated RF clamp achieved a high per centage of PV and LAPW isolation during the 1- and 2-stage proced ures, confirmed by endocardial validation, with low complication -lates and sustained lesion integrity during follow-up.