Sequential hybrid ablation vs. surgical CryoMaze alone for treatment of atrial fibrillation: results of multicentre randomized controlled trial.

Autor:	Bulava A; Faculty of Health and Social Sciences, University of South Bohemia in České Budějovice and Cardiac Centre, České Budějovice Hospital, B. Němcové 54, 370 01 České Budějovice, Czechia., Wichterle D; Cardiology Department, Institute for Clinical and Experimental Medicine, Prague, Czechia., Mokráček A; Faculty of Health and Social Sciences, University of South Bohemia in České Budějovice and Cardiac Centre, České Budějovice Hospital, B. Němcové 54, 370 01 České Budějovice, Czechia., Osmančík P; Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Prague, Czechia., Budera P; Cardiology Department, Institute for Clinical and Experimental Medicine, Prague, Czechia., Kačer P; Third Faculty of Medicine, Charles University and University Hospital Královské Vinohrady, Prague, Czechia., Vetešková L; Centre of Cardiovascular Surgery and Transplantation, Brno, Czechia., Němec P; Centre of Cardiovascular Surgery and Transplantation, Brno, Czechia., Skála T; Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc, Czechia., Šantavý P; Faculty of Medicine and Dentistry, Palacký University and University Hospital Olomouc, Olomouc, Czechia., Chovančík J; Cardilogy Department, Hospital Agel Třinec-Podlesí, Třinec, Czechia., Branny P; Cardilogy Department, Hospital Agel Třinec-Podlesí, Třinec, Czechia., Rizov V; Cardilogy Department, Masaryk Hospital, Ústí nad Labem, Czechia., Kolesár M; Cardilogy Department, Masaryk Hospital, Ústí nad Labem, Czechia., Šafaříková I; Faculty of Health and Social Sciences, University of South Bohemia in České Budějovice and Cardiac Centre, České Budějovice Hospital, B. Němcové 54, 370 01 České Budějovice, Czechia., Rybář M; Faculty of Biomedical Engineering, Czech Technical University in Prague, Kladno, Czechia.
Jazyk:	angličtina
Zdroj:	Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology [Europace] 2024 Feb 01; Vol. 26 (2).
DOI:	10.1093/europace/euae040
Abstrakt:	Aims: Data on the hybrid atrial fibrillation (AF) treatment are lacking in patients with structural heart disease undergoing concomitant CryoMaze procedures. The aim was to assess whether the timely pre-emptive catheter ablation would achieve higher freedom from AF or atrial tachycardia (AT) and be associated with better clinical outcomes than surgical ablation alone. Methods and Results: The trial investigated patients with non-paroxysmal AF undergoing coronary artery bypass grafting and/or valve repair/replacement with mandatory concomitant CryoMaze procedure who were randomly assigned to undergo either radiofrequency catheter ablation [Hybrid Group (HG)] or no further treatment (Surgery Group). The primary efficacy endpoint was the first recurrence of AF/AT without class I or III antiarrhythmic drugs as assessed by implantable cardiac monitors. The primary clinical endpoint was a composite of hospitalization for arrhythmia recurrence, worsening of heart failure, cardioembolic event, or major bleeding. We analysed 113 and 116 patients in the Hybrid and Surgery Groups, respectively, with a median follow-up of 715 (IQR: 528-1072) days. The primary efficacy endpoint was significantly reduced in the HG [41.1% vs. 67.4%, hazard ratio (HR) = 0.38, 95% confidence interval (CI): 0.26-0.57, P < 0.001] as well as the primary clinical endpoint (19.9% vs. 40.1%, HR = 0.51, 95% CI: 0.29-0.86, P = 0.012). The trial groups did not differ in all-cause mortality (10.6% vs. 8.6%, HR = 1.17, 95%CI: 0.51-2.71, P = 0.71). The major complications of catheter ablation were infrequent (1.9%). Conclusion: Pre-emptively performed catheter ablation after the CryoMaze procedure was safe and associated with higher freedom from AF/AT and improved clinical outcomes. Competing Interests: Conflict of interest: none declared. (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)
Databáze:	MEDLINE
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