Surgical ablation for atrial fibrillation superior but riskier than catheter ablation

Surgical ablation for atrial fibrillation superior but riskier than catheter ablation

Surgical ablation for atrial fibrillation: Lucas V A Boersma, Manuel Castella, Wimjan van Boven, Antonio Berruezo, Alaaddin Yilmaz, Mercedes Nadal, Elena Sandoval, Naiara Calvo, Josep Brugada, Johannes Kelder, Maurits Wijffels and Lluís Mont [1] randomized drug refractory atrial fibrillation with left atrial enlargement and hypertension as well as those with failed prior attempts at catheter ablation to either minimally invasive surgical ablation or catheter ablation. Two thirds of the cases had failed catheter ablation earlier.

There were one hundred and twenty four patients of which 82 (67%) had failed prior catheter ablation. Sixty three patients were randomized to catheter ablation and 61 patients to surgical ablation.

The catheter ablation for the study included linear antral pulmonary vein isolation and additional ablation lines if needed. Surgical isolation included bipolar radiofrequency isolation of pulmonary veins on both sides, ablation of ganglionated plexi and excision of left atrial appendage with optional additional lines.

ECG and seven day Holter monitoring were done at six months and twelve months follow up. The primary end point of the study was taken as freedom from atrial arrhythmia more than thirty seconds without antiarrhythmic medications, after 12 months.

Freedom from atrial arrhythmia was more with surgical ablation of 65.5% vs 36.5% with catheter ablation, at twelve months follow up. Procedural complications were more in the surgical group (34.4 percent vs 15.9 percent).

Reference

  1. Lucas V A Boersma, Manuel Castella, Wimjan van Boven, Antonio Berruezo, Alaaddin Yilmaz, Mercedes Nadal, Elena Sandoval, Naiara Calvo, Josep Brugada, Johannes Kelder, Maurits Wijffels, Lluís Mont. Atrial Fibrillation Catheter Ablation Versus Surgical Ablation Treatment (FAST) / Clinical Perspective : A 2-Center Randomized Clinical Trial. Circulation. 2012 Jan 3;125(1):23-30.