Hybrid Ablation Versus Minimally Invasive Surgical Or Transcatheter Ablation For Atrial Fibrillation: A Meta-analysis

Backgrond: Despite successful creation of complex lesion sets during hybrid ablation(HA),reoccurrence of atrial fibrillation(AF)and/or atrial arrhythmia and procedural complications still occur.The main objective of this study was to compare the efficacy and safety between HA and no-hybrid ablation(NHA)including stand-alone minimally invasive surgical ablation or transcather ablation.Methods: We searched Pubmed,Embase and the Cochrane Central Register of Controlled Trials(CENTRAL)database up to October 2017.Studies that satisfied our predefined inclusion criteria were included.Of the 894 records,5 studies encompassing 394 patients were included in our study.We assessed pooled data using random-effect or fixed-effect model.The main endpoints were freedom of atrial arrhythmia after follow-up duration,procedure time,endocardial and fluoroscopy time.Secondary results were post-operative hospitalization,intra-operative and post-operative adverse events.Results: Compared with NHA,HA treatment through mini-thoracotomy access improved superiority in freedom of atrial arrhythmia after follow-up duration(OR =5.19,95% CI: 2.36-11.41),but HA increased the incidence of intra-operative and post-operative adverse events for AF patients(OR = 2.36,95% CI: 1.06-5.23).HA through either mini-thoracotomy or transdiaphragmatic access had longer procedure time than NHA.However,endocardial time was shorter than NHA.Conclusions: For AF patients,HA possessed of an overall superior outcome using mini-thoracotomy way to NHA.Although HA had longer procedure time,it yielded a reduction in endocardial time.Meanwhile,we should pay attention to a significant high risk of intra-operative and post-operative adverse events that the HA generated.