Hybrid versus catheter ablation in patients with persistent and longstanding persistent atrial fibrillation: a systematic review and meta-analysis

Claudia A. J. van der Heijden, Mindy Vroomen, Justin G. Luermans, Rein Vos, Harry J. G. M. Crijns, Sandro Gelsomino, Mark La Meir, Laurent Pison, Bart Maesen*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

32 Citations (Web of Science)

Abstract

As the mechanisms underlying persistent atrial fibrillation (AF) are still incompletely understood, a 'gold standard' strategy for ablation is lacking. The results of catheter ablation, independent of the ablation strategy applied, are disappointing. Hybrid ablation, combining a thoracoscopic epicardial and transvenous endocardial approach, has shown more favourable outcomes. To date, studies comparing both techniques are lacking. Therefore, we conducted a systematic review and meta-analysis of hybrid versus catheter ablation in patients with persistent or longstanding persistent AF. A systematic literature search of studies reporting on catheter and hybrid ablation of persistent or longstanding persistent AF was performed in the PubMed database. All identified articles were screened and checked for eligibility. A meta-analysis was performed on inter-study heterogeneity and pooled correlation between baseline characteristics, primary and secondary outcomes of hybrid and catheter studies. From the 520 articles identified by the search, 34 articles could be included in the analysis. Hybrid ablation resulted in higher freedom of atrial arrhythmias in patients with persistent and longstanding-persistent AF than catheter ablation (70.7% vs 49.9%, P <0.001). Although hybrid ablation had a slightly higher complication rate than catheter ablation, overall morbidity and mortality were low. In conclusion, hybrid ablation is more effective than catheter ablation in maintaining the sinus rhythm in patients with persistent or longstanding persistent AF. However, data directly comparing both techniques are lacking, and small, heterogenic, single-arm studies in a random-effects model prevent definite conclusions from being drawn. Therefore, larger randomized controlled trials directly comparing both techniques are needed.

Original languageEnglish
Pages (from-to)433-443
Number of pages11
JournalEuropean Journal of Cardio-Thoracic Surgery
Volume56
Issue number3
DOIs
Publication statusPublished - Sep 2019
Event32nd Annual Meeting of the European-Association-for-Cardio-Thoracic-Surgery - Milan, Italy
Duration: 18 Oct 201820 Oct 2018

Keywords

  • Persistent atrial fibrillation
  • Hybrid ablation
  • Catheter ablation
  • Systematic review and meta-analysis
  • PULMONARY VEIN ISOLATION
  • GANGLIONATED PLEXUS ABLATION
  • ENDOCARDIAL ABLATION
  • LINEAR ABLATION
  • ELECTROPHYSIOLOGICAL FINDINGS
  • CLINICAL-OUTCOMES
  • APPENDAGE
  • RECURRENCE
  • STRATEGIES
  • LESIONS

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