Article Impact Level: HIGH Data Quality: STRONG Summary of JACC: Clinical Electrophysiology, S2405500X22011434. https://doi.org/10.1016/j.jacep.2022.12.011 Dr. Claudia van der Heijden et al
Points
- Compared to catheter ablation, the HARTCAP-AF trial found that hybrid (surgical plus catheter) ablation resulted in more participants in sinus rhythm and no longer requiring antiarrhythmic medication therapy.
- Hybrid ablation excelled in catheter ablation in patients who had persistent atrial fibrillation.
- At 12 months, hybrid ablation enhanced atrial fibrillation freedom from off-antiarrhythmic medication therapy.
- Despite effectively treating paroxysmal atrial fibrillation, catheter ablation offers fewer favorable outcomes for treating persistent atrial fibrillation. Individuals with persistent atrial fibrillation who undergo hybrid ablation show superior outcomes. Hybrid is the combination of a thoracoscopic pericardial and transvenous endocardial technique.
Summary
The investigation aimed to compare catheter and hybrid (surgical plus catheter) ablation in participants with persistent atrial fibrillation.
The study design was randomized and parallel; participants with persistent atrial fibrillation were divided into two categories. One group was assigned to hybrid ablation (n=19), and the other group (n=22) was allocated to the catheter ablation category.
The average age of the participants was 64 years, and most were diabetic. The study’s inclusion criteria were based on individuals with symptomatic persistent atrial fibrillation receiving antiarrhythmic medication therapy and who had not undergone catheter ablation in the past.
The study did not include participants with a left atrial diameter of more than 60mm, a body mass index of more than 40 kilograms per square meter square, a past medical history of heart surgery, and a shorter life span. Moreover, women who were pregnant or who had any contraindication for ablation were also excluded.
The primary goal was achieved by 89% of the hybrid ablation group; they did not experience atrial tachyarrhythmia more than five minutes off antiarrhythmic medicines at 12 months compared to 41% of the catheter ablation group.
The incidence of significant adverse effects was the same between groups; however, the secondary adverse effects differed. The primary adverse effects ratio was 5% in catheter ablation and 5% in the hybrid ablation group. The secondary adverse effects ratio was 21% in the hybrid ablation and 14% in the catheter ablation group.
Both treatment groups experienced one serious adverse event; a bleeding incident in the catheter ablation group and pericarditis in the hybrid ablation group. Across the mentioned groups, the adverse outcomes were the same. Despite the relatively modest size of this study, the findings supported the use of a hybrid strategy to manage persistent atrial fibrillation.
Link to the article: https://www.jacc.org/doi/10.1016/j.jacep.2022.12.011
References Van Der Heijden, C. A. J., Weberndörfer, V., Vroomen, M., Luermans, J. G., Chaldoupi, S.-M., Bidar, E., Vernooy, K., Maessen, J. G., Pison, L., Van Kuijk, S. M. J., La Meir, M., Crijns, H. J. G. M., & Maesen, B. (2023). Hybrid ablation versus repeated catheter ablation in persistent atrial fibrillation. JACC: Clinical Electrophysiology, S2405500X22011434. https://doi.org/10.1016/j.jacep.2022.12.011
