Atrial Fibrillation
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Nicolas Doll, EHRA 2023: The CEASE AF trial, hybrid total thoracoscopic ablation therapy in patients with long standing persistent atrial fibrillation

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Published Online: May 18th 2023

CEASE-AF is a trial comparing the efficacy and safety of hybrid total thoracoscopic ablation therapy to standard catheter ablation in patients with long standing persistent atrial fibrillation. In this touchCARDIO interview, we speak with Dr Nicolas Doll (Schuechtermann-Clinic, Bad Rothenfelde, Germany) to discuss the CEASE AF trial and the potential clinical significance. 

The abstract entitled ‘CEASE AF: Primary Efficacy and Safety Endpoints’ was presented at the European Heart Rhythm Association congress, 16–18, April 2023.


  1. Can you give us a brief overview of Hybrid Total Thoracoscopic Ablation Therapy? (0:18)
  2. What are the aims, design, and eligibility criteria of the CEASE AF trial? (1:22)
  3. What were the primary efficacy and safety endpoints, and how well were they achieved? (2:28)
  4. What is the potential clinical significance of these findings? (3:56)

Disclosures: Nicolas Doll is a consultant for Atricure and NeoChord, is on the advisory board for Medtronic, and has received honoraria from Atricure, NeoChord and Medtronic.

Support: Interview and filming supported by Touch Medical Media. Interview conducted by Danielle Crosby.

Filmed as a highlight of EHRA 2023

Access more content on atrial fibrillation here



My name is Nicolas Doll. I’m a cardiac surgeon. I’m head of the Department at the Schuechtermann-Clinic, Bad Rothenfelde, it’s located in between Hanover and Hamburg in Germany. 

Q. Can you give us a brief overview of Hybrid Total Thoracoscopic Ablation Therapy?

Hybrid means that cardiac surgeon and electrophysiologist should work together. It is a 2-step approach, and the hybrid procedure consists of a minimally invasive, total endoscopic approach of epicardial ablation; it is an isolation of the pulmonary veins and isolation of the posterior wall of the left atrium. It is the so-called box lesion and this also included a closure of the left atrial appendage. In addition to that, as a second step in all patients, we have performed a catheter ablation to see how effective our lines, the surgical lines, were and to add more lines or to close gaps. The other arm of this study was multiple catheter ablation. 

Q. What are the aims, design, and eligibility criteria of the CEASE AF trial?

The hypothesis was that the epi- and endocardial ablation in the hybrid cohort is beneficial compared with isolated catheter ablation on multiple catheter ablation. 

Our patient population was patients with persistent atrial fibrillation and enlarged left atria or patients with longstanding persistent atrial fibrillation. That means that the atrial fibrillation lasts longer than 1 year in this cohort and that induces more fibrosis and these are the patients who are challenging.

We randomized these patients in a 2:1 fashion to hybrid versus catheter ablation. We compared this in the prospective multicentre European randomized controlled trial. We have enrolled 170 patients. 

Q. What were the primary efficacy and safety endpoints, and how well were they achieved?

At the beginning, we would not have thought that we have such a huge gap in these groups. We could find that the primary effectiveness was 32.4 absolute benefit in favour of the hybrid ablation compared with the catheter arm. So this is really a huge difference. The relative benefit was 82.7% in favour of hybrid. We compared, of course, the complications and we compared a surgical approach plus a catheter ablation to multiple catheter ablations. In the past, we could always see more complications in the surgical arm. In this study, we had no significant difference. So we had not seen any differences in severe complications in both arms. This is a nice finding. We could demonstrate that this approach is very safe for the patient and we do not have more dangerous complications when we perform surgery. 

Q. What is the potential clinical significance of these findings?

We hope at the end that this study will influence the guidelines. We hope that these very good results will bring EPs and cardiac surgeons together in order to improve outcomes. With this study, we could show that at the end, to sum it up, together we are better in the treatment of advanced atrial fibrillation. 

Subtitles and transcript are autogenerated

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