96-20: Hybrid ablation for long-standing persistent AF. A 2 stage non-concomitant approach using the Cobra Fusion Device and catheter ablation - single-centre experience

Introduction: Treatment of long-standing persistent Atrial Fibrillation (LsPsAF) remains challenging, with the optimal ablative approach unclear. We describe our experience in non-concomitant hybrid AF ablation using the Cobra Fusion device followed by catheter ablation. Methods: LsPsAF patients with unfavourable characteristics for catheter ablation alone (continuous AF duration >1 year, enlarged left atrium (LA), previous failed catheter ablation) are chosen for the procedure. The first stage is a right, video-assisted thoracoscopic (VATS) approach. The Cobra Fusion RF system (Atricure Inc, West Chester, OH) is used to deliver epicardial RF ablation forming a “box lesion” to isolate the LA Posterior Wall (LAPW). All patients then return for a staged catheter procedure approximately 60 days later, with, if required, additional lesions to complete LAPW isolation. The procedure is completed with a cavo-tricuspid isthmus ablation line. Summary of Results: 41 patients had the VATS procedure. Epicardial ablation was performed in 38 (2 had dense pericardial adhesions). 1 patient had a CVA which developed 24 hours post operatively and 5 patients developed a transient phrenic nerve palsy post op. 24 patients have undergone the 2nd catheter ablation stage. The LAPW was isolated at baseline in 7 patients. Posterior wall isoloation was achieved at 2nd stage in all but 1. 9 patients have greater than 1 year follow up. 7 of them (78%) are in SR with only 1 on antiarrhythmics (AA) (13%). 21 patients have greater than 3 months follow up. Of those, 17 remain in SR with only 3 of them on AA. Conclusions: 81% of LsPsAF patients in our series are in sinus rhythm on preliminary follow-up following non-concomitant hybrid ablation. 77% are in SR at over 1 year post the 2nd stage procedure with the longest follow-up patients now over 2 years. Further research is required to determine long-term outcomes from this technique, but these results are encouraging for patients with LsPsAF.