Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin.
Aurora Research Institute, Aurora Sinai/Aurora St. Luke's Medical Centers, Milwaukee, Wisconsin.
JACC Clin Electrophysiol. 2017 Apr;3(4):341-349. doi: 10.1016/j.jacep.2016.10.010. Epub 2016 Dec 21.
The outcomes of hybrid ablation versus endocardial catheter ablation alone were evaluated in patients with persistent and long-standing persistent atrial fibrillation (AF).
Variable outcomes exist following endocardial catheter ablation in medically refractory patients with persistent AF. A hybrid epicardial-endocardial approach has emerged as an alternative to endocardial ablation.
In 133 consecutive patients, 69 received endocardial ablation alone (pulmonary vein isolation and radiofrequency catheter ablation [endo group]) and 64 received endocardial catheter ablation and epicardial ablation (hybrid group). Recurrence was defined as any arrhythmia following the 3-month blanking period.
Patients were followed for a median of 16 months. The hybrid and endo groups were similar in age (61 ± 10 years vs. 62 ± 8 years), body mass index (35 ± 6 kg/m vs. 35 ± 7 kg/m), CHAD-VASc score (2 ± 1 vs. 2 ± 1), and ejection fraction (54 ± 11% vs. 53 ± 8%). The hybrid group had longer AF duration (median [interquartile range (IQR)] (12 months [IQR: 8 to 28 months] vs. 7 months [IQR: 5 to 12 months]; p < 0.001) and more previous ablations (58% vs. 25%; p < 0.001). Both groups had similar antiarrhythmic drug use at follow-up (55% vs. 48%). The hybrid group was less likely to have recurrence (37% vs. 58%; p = 0.013) and repeat ablation (9% vs. 26%; p = 0.012), and had an AF-free survival of 72% versus 51% (p = 0.01).
Among patients with persistent AF, hybrid ablation is associated with less AF recurrence and fewer re-do ablations. Prospective large-scale randomized trials are needed to validate these results.
评估在持续性和长程持续性心房颤动（房颤）患者中，混合消融与单纯心内膜导管消融的结果。
对于药物难治性持续性房颤患者，心内膜导管消融后的结果存在差异。心外膜-心内膜杂交方法已成为心内膜消融的替代方法。
在 133 例连续患者中，69 例仅接受心内膜消融（肺静脉隔离和射频导管消融[endo 组]），64 例接受心内膜导管消融和心外膜消融（杂交组）。复发定义为空白期后任何心律失常。
患者中位随访 16 个月。杂交组和 endo 组在年龄（61±10 岁比 62 ± 8 岁）、体重指数（35±6 kg/m 比 35 ± 7 kg/m）、CHAD-VASc 评分（2 ± 1 比 2 ± 1）和射血分数（54 ± 11%比 53 ± 8%）方面相似。杂交组房颤持续时间更长（中位数[四分位距（IQR）]（12 个月[IQR：8 至 28 个月]比 7 个月[IQR：5 至 12 个月]；p<0.001），且先前消融次数更多（58%比 25%；p<0.001）。两组在随访时抗心律失常药物的使用情况相似（55%比 48%）。杂交组复发率较低（37%比 58%；p=0.013）和重复消融率较低（9%比 26%；p=0.012），无房颤生存率为 72%比 51%（p=0.01）。
在持续性房颤患者中，杂交消融与房颤复发减少和重复消融减少相关。需要前瞻性大规模随机试验来验证这些结果。
