63. Long-Term Outcomes for Patients Undergoing Hybrid Ablation for Atrial Fibrillation

Objective:
Hybrid ablation (HA) for atrial fibrillation consists of a thoracoscopic epicardial ablation followed by an endocardial, catheter ablation. Several small randomized clinical trials have demonstrated the efficacy of this approach, however the data is limited by modest sample sizes with limited follow up. In this study we evaluate the long-term efficacy of HA in a large single institution series with the longest follow up.

Methods:
Patients with documented atrial fibrillation underwent HA between the years of 2015 and 2024 at a single institution with a single surgeon. Patient medical records were reviewed for demographics, comorbidities, recurrence of atrial fibrillation, cessation of anti-arrhythmic medications, length of hospital stay, stroke, and death. Recurrence was defined as atrial fibrillation or atrial flutter > 30 seconds in duration beyond a 90-day blanking period on 24 hour or longer continuous monitoring. Patients were followed for up to 9 years. A multivariable logistic regression model was also generated to relate demographics and preoperative risk factors to whether patients experienced AF recurrence.

Results:
304 patients were identified who underwent HA between the years of 2015 and 2024. The median age was 68 (IQR 62-73) and 73% were male. At one year 81% of patients were in normal sinus rhythm (NSR), 74% were off all class I and class III anti-arrhythmic drugs (AADs), and 50% were off anti-coagulation (AC). The percentage of patients in NSR, and off AADs can be seen through five years in Figure 1. 65% of cases were done through a left sided only thoracoscopic approach, which was associated with a mildly shorter hospital length of stay compared to bilateral thoracoscopic approach (4 days vs 5 days, p=0.0038). 8 patients (2.6%) required conversion to open Maze and 30-day mortality occurred in 3 patients (0.9%). Multivariable logistic regression demonstrated that COPD and prior open cardiac surgery were statistically significant predictors of AF recurrence at 1 year.

Conclusion:
To our knowledge, this represents the largest single institution study of hybrid ablation patient outcomes to date with the longest follow up. Hybrid ablation achieved excellent short and long-term freedom from atrial fibrillation with acceptably low rates of complication or conversion to open surgery.

Gabe Weininger (1), Joy Aparicio Valenzuela (2), Tiffanie Yau (1), Andre Vu (2), Sabrina Sanchez (2), Terrence Pong (1), Anson Lee (1), (1) Stanford Department of Cardiothoracic Surgery, Stanford, CA, (2) Stanford University School of Medicine, Stanford, CA

Lawrence Wei

Commentator

Lawrence Wei attended the University of Pittsburgh School of Medicine and also completed his General Surgery and Cardiothoracic Surgery residencies at Pitt.  After starting his career in private practice, he joined the faculty of the University of Pittsburgh in the Department of Cardiothoracic Surgery in 1995 and over the next twenty one years maintained a practice in adult cardiac surgery and developed a passion for teaching. He directly participated in the development of more than fifty cardiothoracic surgeons, a number of whom have risen to leadership positions in the specialty.  In 2017, he transitioned to West Virginia University, where he has maintained a diverse clinical practice and continues to teach and mentor residents, fellows, and students. He has helped to develop several clinical programs, most notably in robotic cardiac surgery. 

Gabe Weininger

Abstract Presenter

Gabe Weininger is a PGY2 in the Integrated Cardiothoracic Surgery Residency Program at Stanford University. He is a member of the Y. Joseph Woo laboratory and collaborates with Dr. Anson Lee on surgical ablation research. Gabe is a graduate of Yale School of Medicine and Stanford University. In his spare time he is an avid skier.