Comparison Between Hybrid Surgical And Catheter Ablation And Video-Assisted Thoracoscopic Surgical Ablation For Non-valvular Atrial Fibrillation

Objective:This study aimed to evaluate the risk factors for postoperative recurrence of paroxysmal atrial fibrillation(AF)after video assisted thoracoscopic surgical(VATS)ablation,and to verify whether hybrid surgical and interventional ablation for the treatment of persistent AF is superior to VATS ablation.Contents:It's reported that there are good early results in paroxysmal AF treated by VATS ablation,but there are still a small minority of patients with postoperative recurrence.The new techniques of hybrid surgical and interventional ablation take full advantage of VATS ablation and catheter ablation.Theoretically,the effect of hybrid surgical and interventional ablation should be superior to that of VATS ablation.However,the pathogenesis of persistent AF is complex and unclear.Whether there are differences in the efficacy of the two therapies for persistent AF need to be verified.The present study retrospectively analyzed the clinical results of non-valvular AF treated with VATS ablation and hybrid surgical and interventional ablation in Fuwai Hospital in the past 7 years.According to the long-term results of VATS ablation for paroxysmal AF,the risk factors for postoperative recurrent AF were analyzed.In addition,the efficacy of hybrid surgical and interventional ablation and VATS ablation for the treatment of persistent AF was compared.Methods:From September 2010 to December 2017,151 consecutive patients with non-valvular AF underwent VATS ablation or hybrid surgical and interventional ablation in Fuwai Hospital,including 72 cases of paroxysmal AF and 79 cases of persistent AF.Box-lesion ablation was applied in the treatment of paroxysmal AF by VATS ablation.Sixty patients with persistent AF underwent VATS ablation(stand-alone surgical group)and nineteen patients with persistent AF underwent hybrid surgical and interventional ablation(hybrid group).Follow-up was completed at 3 months,6 months,1 year and annually thereafter.Postoperative sinus rhythm was defined as sinus rhythm was recorded in 24-hour or 7-day Holter during follow-up,without exhibited rapid atrial tachyarrhythmia with duration ? 30 s including AF,atrial flutter,or atrial tachycardia.Logistic regression model was used to analyze the risk factors for postoperative recurrence after VATS ablation for paroxysmal AF.The superiority test of the efficacy between stand-alone surgical group and hybrid group was performed by the chi-square test.Results:69 patients with paroxysmal AF(95.8%)were followed up for an average of 43±20 months.Overall sinus rhythm maintenance rate was 73.9%and sinus rhythm maintenance rate free from anti-arrhythmic drugs(AADs)was 62.3%.Subgroup analysis showed that sinus rhythm maintenance rates were 80%and 57.9%(Log Rank=0.018)in patients with LAD ?40mm and>40mm,respectively.Cox regression model analysis showed that LAD>40mm was an independent risk factor of recurrent AF after paroxysmal AF treated by VATS ablation.78 patients(98.7%)completed the follow-up.The mean follow-up time was 24±21 months and 19±12 months in stand-alone surgical group and hybrid group separately and there was.no difference between the two groups(P=0.191).Although the preoperative LAD(49.1 ± 5.3)mm in hybrid group was significantly greater than stand-alone surgical group(41.7 ± 6.2)mm(P<0.001),overall sinus rhythm maintenance rate in hybrid group was significantly greater than stand-alone surgical group(94.7%and 64.4%,P=0.011).and sinus rhythm maintenance rate free from AADs and catheter ablation in hybrid group was significantly greater than stand-alone surgical group(84.2%and 50.8%,P=0.010).Conclusion:LAD>40mm was an independent risk factor of recurrent AF after paroxysmal AF treated by VATS ablation.Hybrid surgical and interventional ablation is superior to VATS ablation in the treatment of persistent AF,but a larger sample size is needed for further validation in prospective studies.