New hope for patients and challenges for the multidisciplinary arrhythmia team: a hybrid convergent approach for atrial fibrillation treatment
| Autor: | Witold Bratkowski, Mariusz Gąsior, Michał Zembala, Zbigniew Kalarus, Piotr Buchta, Krzysztof J. Filipiak, Radosław Sierpiński, Oskar Kowalski, Krzysztof Myrda |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Catheter ablation 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Multidisciplinary approach Internal medicine Atrial Fibrillation Humans Medicine Heart Atria Adverse effect Retrospective Studies business.industry Incidence (epidemiology) Atrial fibrillation Retrospective cohort study Middle Aged medicine.disease Ablation Treatment Outcome Catheter Ablation Cardiology Cardiology and Cardiovascular Medicine business Cardioversions Endocardium |
| Zdroj: | Kardiologia Polska. 78:1243-1253 |
| ISSN: | 1897-4279 0022-9032 |
| DOI: | 10.33963/kp.15640 |
| Popis: | Background: Available data suggest the important role of ablation of the left atrial posterior wall and epicardial myocardial layers in rhythm control therapy in patients with persistent drug‑refractory atrial fibrillation (AF). However, endocardial ablation is not always effective in transmural substrate modification. The alternative treatment option is minimally invasive hybrid approach (HABL) combining the strengths of surgical and catheter ablation. Aims: This study aimed to assess the periprocedural safety as well as acute and long‑term outcomes of HABL for AF. Methods: This is a retrospective single‑center study of patients who underwent HABL using the minimally invasive transabdominal approach between July 2009 and January 2020. Demographic in‑hospital data and 12‑month follow‑up results were obtained. The number of hospitalizations, cardioversions, re‑ablations, and severe adverse events in a 3‑year period before and after HABL were compared using data from the national healthcare provider. Results: In total, 158 patients (mean [SD] age, 51.02 [10.67] years) who underwent HABL were included; 61.4% had persistent AF. There was a 4.4% incidence of periprocedural complications without any fatalities. In 66% of patients, additional endocardial substrate modification was needed, in 52.6% on the posterior wall. In the 12‑month follow‑up, most patients (78.3%) remained free of arrhythmias. There was a significant reduction in the number of hospitalizations (for AF, 1.65 vs 0.54; or any other cause, 2.56 vs 1.31 per patient), cardioversions, and re‑ablations after HABL (all P < 0.05). Conclusions: The hybrid multidisciplinary approach for treatment of AF is a safe and very effective treatment method in long‑term follow‑up, which reduces healthcare burden. It could be considered as an alternative therapeutic option especially in patients with persistent AF. |
| Databáze: | OpenAIRE |
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