Objective

Outcomes for catheter ablation of long-standing persistent atrial fibrillation (LsPsAF) are inferior to those of paroxysmal atrial fibrillation and the optimal ablation strategy remains unclear. We describe our experience of non-concomitant hybrid ablation for LsPAF using a suction based surgical RF ablation system.

Methods

The first surgical stage is performed via a right-sided video assisted thoroscopic approach (VATS). Patients then return for a staged endocardial mapping and if required catheter ablation to complete the ‘box’ and create a cavo-tricuspid isthmus line.

Results

32 patients are currently under follow-up: (all values median) 28M/4F, age 65, CHADSVASc – 2. Following epicardial ablation acute LAPW isolation with conduction block was demonstrated in 53%.Twenty-one patients have undergone the 2nd stage. Median f/u 12 months (4-21 months) from 2nd stage procedure. 4 patients required DCCV in first 4 months. 14/14 currently in SR. 2 on Antiarrhythmic Drugs (sotolol, amiodarone). 10/14 patients have 7/7 loop monitor/PPM/ICD at 1 year showing SR

Conclusion

Non-concomitant hybrid AF ablation provides excellent medium term outcomes in the treatment of longstanding persistent atrial fibrillation. Future randomised study comparing the technique with catheter ablation alone is needed before this becomes the procedure of choice.