초록접수 현황
| 16F-159 | 구연 발표 |
Thoracoscopic Ablation Only Versus Staged Hybrid Procedure in Persistent Atrial Fibrillation: A Prospective Randomized Controlled Trial
Chang-Seok Jeon, Dong Seop Jeong
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
Background : We examine whether post-procedural electrophysiological confirmation reduced early atrial arrhythmia recurrence after totally thoracoscopic ablation in patients with lone persistent AF.
Methods : Forty-six patients with lone persistent AF were randomized into two groups, those who did and did not receive electrophysiological confirmation after totally thoracoscopic ablation (the TTA group [n = 23] and the hybrid group [n = 23], respectively). The primary end point, AF-related event, was defined as atrial arrhythmia recurrence, cardioversion or additional ablation. An intention-to-treat approach was used.
Results : There were no intergroup differences in preoperative characteristics or echocardiographic parameters including sex, AF duration, CHA2DS-VASc score or left atrial volume index. In the TTA group, three patients (13%, 3 of 23) required cavo-tricuspid-isthmus ablation due to symptomatic typical atrial flutter before discharge. In the hybrid group, eight patients (35%, 8 of 23) required additional ablation due to residual potential in the left atrium including eight touch-up ablations for gaps around the pulmonary vein isolation lines and six ablations of the mitral isthmus. During follow up, normal sinus rhythm was maintained in 21 patients in the TTA group and 22 patients in the hybrid group (91% versus 96%, P = 0.500). AF-related events occurred in seven patients in the TTA group and two patients in the hybrid group (30.4% versus 8.7%, P = 0.067). In multiple logistic regression analysis, preoperative left atrial volume index (odds ratio 1.1, 95% CI 1.0 to 1.1, P = 0.045) and lack of post-procedural electrophysiological confirmation (odds ratio 9.5, 95% CI 1.1 to 80.6, P = 0.039) were associated with AF-related events during follow-up.
Conclusion : Post-procedural electrophysiological confirmation after totally thoracoscopic ablation reduced the likelihood of early AF-related events. Among patients undergoing totally thoracoscopic ablation, 24% (11 of 46) required additional ablation due to residual potential or atrial flutter.
Methods : Forty-six patients with lone persistent AF were randomized into two groups, those who did and did not receive electrophysiological confirmation after totally thoracoscopic ablation (the TTA group [n = 23] and the hybrid group [n = 23], respectively). The primary end point, AF-related event, was defined as atrial arrhythmia recurrence, cardioversion or additional ablation. An intention-to-treat approach was used.
Results : There were no intergroup differences in preoperative characteristics or echocardiographic parameters including sex, AF duration, CHA2DS-VASc score or left atrial volume index. In the TTA group, three patients (13%, 3 of 23) required cavo-tricuspid-isthmus ablation due to symptomatic typical atrial flutter before discharge. In the hybrid group, eight patients (35%, 8 of 23) required additional ablation due to residual potential in the left atrium including eight touch-up ablations for gaps around the pulmonary vein isolation lines and six ablations of the mitral isthmus. During follow up, normal sinus rhythm was maintained in 21 patients in the TTA group and 22 patients in the hybrid group (91% versus 96%, P = 0.500). AF-related events occurred in seven patients in the TTA group and two patients in the hybrid group (30.4% versus 8.7%, P = 0.067). In multiple logistic regression analysis, preoperative left atrial volume index (odds ratio 1.1, 95% CI 1.0 to 1.1, P = 0.045) and lack of post-procedural electrophysiological confirmation (odds ratio 9.5, 95% CI 1.1 to 80.6, P = 0.039) were associated with AF-related events during follow-up.
Conclusion : Post-procedural electrophysiological confirmation after totally thoracoscopic ablation reduced the likelihood of early AF-related events. Among patients undergoing totally thoracoscopic ablation, 24% (11 of 46) required additional ablation due to residual potential or atrial flutter.
책임저자: Dong Seop Jeong
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
발표자: Chang-Seok Jeon, E-mail : csjeonmd@gmail.com