Table 3. Systematic Review of Hybrid Ablation Studies – Outcomes.
83 Journal of Atrial Fibrillation Featured Review Featured Review *Excludes readmissions for delayed staged procedures; **Excludes 7 patients reported by Lee et al56 as results pooled with 18 patients undergoing non-hybrid minimally invasive AF surgery; $Data for all minimally invasive patients including 7 with hybrid and 18 with non-hybrid surgical ablation, with 12 month follow-up; #1 sudden death, 1 death from atrioesophageal fistula PAF – Paroxysmal AF, PrAF – persistent AF, LSPrAF – long-standing persistent AF; NA - not available
| First Author | No. patients | AF type: PAF/PrAF/LSPrAF | Procedure time (min) | Hospital stay (days)* | Death (N) | Death or Major Complication (N) | Acute non-fatal thromboembolism (N) | Major Surgical Complications (non-embolic, non fatal) (N) | No. with minimum 12-month FU | Confirmation of AF recurrence | 12-month AAD-free SR maintanance – All (N) | 12-month AAD free FU for PAF (N) | 12-month AAD free FU for PrAF/LSPrAF |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Thoracoscopic Clamp-based Approach | 88.1% | 78.3% | 88.2% | ||||||||||
| Mahapatra[57] | 15 | 0/9/6 | Both components: mean 450±20 | median 5.0 (IQR 5.0–5.5) | 0 | 0 | 0 | None | 14 | 7 day event monitor, AF >30 secs | 13/14 | - | 13/14 |
| Lee[56] | 7 | NA | NA | median 5 (IQR 4-6)* | 0 | 1 | 0 | 1 prolonged ventilation postop* | NA | Continuous ECG monitoring (duration and criteria not stated) or pacemaker/ICD monitoring | (12/23)$ | NA | NA |
| Pison[33] | 26 | 15/10/1 | Both components: mean 280±84 | mean 7±2 | 0 | 2 | 0 | 1 pleural effusion requiring drainage, 1 surgical incision pain prolonging hospital stay | 24 | 7-day Holter monitoring, AF/AT >30 secs | 20/24 | 11/15 | 10/11 |
| La Meir[62] | 35 | 16/8/11 | Both components: median 268 (IQR 186–477) | median 3.4 (IQR 2.6–4.1) | 0 | 0 | 0 | None | 35 | 7 day Holter, AF/AT >30 secs | 32/35 | 14/16 | 16/19 |
| Kurfirst[63] | 30 | 0/0/30 | Surgical component: mean 210±30 | mean 4.5±3 | 0 | 5 | 0 | 2 left pulmonary artery bleeding requiring sternotomy, 2 phrenic nerve palsies persistent at 12 months, 1 tamponade postop day 24 with overanticoagulation | 0 | 7 day Holter, AF/AT >30 secs | (27/30 at mean 208±29 days) | - | (27/30 at mean 208±29 days) |
| Lee[64] | 10 | 1/0/9 | Surgical component: mean 221 | median 12 | 0 | 3 | 1 stroke | 1 reexpansion pulmonary edema and pneumonia, 1 pericardial effusion | 0 | Holter (duration not specified) AF/AT >30 secs | (10/10 at median 7.6 months [range 6.7 - 11.6]). | NA | NA |
| Pison[65] | 78 | 29/34/15 | NA | median 6 (IQR 5.5-8) | 0 | 6 | 0 | 1 reoperation for bleeding, 1 bleeding not requiring reoperation, 2 pneumonia, 2 complete heart block requiring pacemaker implantation | 78 | 7 day Holter, AF/AT >30 secs | 68/78 | 22/29 (76%) | 43/49 |
| Thoracoscopic Encircling Catheter - based Approach | 73.4% | 60.0% | 74.6% | ||||||||||
| La Meir[59] | 19 | 5/4/10 | Both components: median 216 (IQR 132–391) | median 3.6 (IQR 2.7–4.3) | 0 | 0 | 0 | None | 19 | 7 day Holter, AF/AT >30 secs | 7/19 | 3/5 | 4/14 |
| Bisleri[60] | 45 | 0/0/45 | Epicardial component: mean 85±9 | mean 3.9±1.4 | 0 | 0 | 0 | None | 45 | ILR, AF>5 min or overall AF burden >0.5% | 40/45 | - | 40/45 |
| Subxiphoid Convergent Approach | 59.3% | - | 51.5% | ||||||||||
| Gehi[61] | 101 | 17/37/47 | NA | mean 4.4 | 2# | 7 | 1 TIA | 2 retroperitoneal bleeding, 2 tamponade | 69 | 24 hour Holter, AF/AT >30 secs | 46/69 | NA | NA |
| Gersak[66] | 73 | 0/22/51 | Surgical component: 112±38 | NA | 0 | 8 | 1 stroke | 2 bleeding requiring sternotomy, 2 bleeding not requiring reoperation, 1 tamponade, 1 pericardial effusion, 1 pleural effusion | 66 | ILR (n=48/73) or Holter (24 hours or 7 days), criteria not stated | 34/66 | - | 34/66 |
| TOTAL** | 432 | 83/124/225 | 2 | 32 | 3 | 27 | 350 | 260 | 50 | 160 | |||
| % of TOTAL | 0.5% | 7.4% | 0.7% | 6.3% | 81.0% | 74.3% | 76.9% | 73.4% | |||||