Background: The objective of this single-centre study was to compare the long-term efficacy and safety outcomes of the hybrid AF ablation approach with cryoballoon ablation procedure for the treatment of atrial fibrillation. In the absence of randomised clinical trials, we conducted a propensity-score-matched comparison of those that had AF ablation via the hybrid approach and cryoballoon ablation only.
Methods: In this study, thirty-five patients had AF ablation via the hybrid approach, with at least a 6-month follow up duration after the endocardial ablation procedure. An equal number of 35 patients who had cryoballoon ablation for AF were propensity score matched in a 1:1 ratio. The epicardial and endocardial ablation procedures were performed sequentially in a staged manner, in keeping with local protocol.
Results: Seventy patients (age 70 ± 8 years, ejection fraction 0.55 ± 0.09, left atrial size 45 ± 6 mm, median body mass index of 32) with paroxysmal and persistent AF were analysed. Fifty-eight (83%) of the patients had persistent AF. After a median follow-up of 28 (9–36) months, 18 (51.4%) of the hybrid group and 14 (40%) of the cryoballoon group were free from arrhythmia without antiarrhythmic medication (p=0.23). There were no major complications except one inferior vena cava rupture in the hybrid group, which was treated successfully.
Conclusions: Long term outcomes for the hybrid AF ablation approach are promising and demonstrate the ability to maintain sinus rhythm in predominantly obese patients with a significantly dilated left atrium.