B-PO02-115 MINIMALIST APPROACH TO HYBRID ABLATION FOR ATRIAL FIBRILLATION: FEASIBILITY & EFFICACY OF UNILATERAL EPICARDIAL ACCESS

Hybrid ablation surgery for atrial fibrillation (AF) has evolved from bilateral to unilateral left-sided only video-assisted thoracoscopic surgical techniques. However, an optimal strategy for hybrid AF ablation that optimizes patient wellbeing and hospital expenditures remains undetermined. To evaluate the feasibility and efficacy of hybrid ablation surgery for treatment of AF, and perform the first evaluation of unilateral left-sided versus bilateral epicardial access. Patients with documented AF who underwent hybrid ablation consisting of thoracoscopic epicardial ablation with percutaneous catheter based endocardial ablation for treatment of atrial fibrillation were followed post-operatively for major events. Major events were classified into two categories consisting of 1) feasibility, comprising all-cause mortality and major morbidities, and 2) efficacy, which included recurrence of atrial arrhythmia, cessation of antiarrhythmic drugs (AAD), and completeness of lesion set. A total of 84 consecutive patients were consented for hybrid ablation. Patients presented with an average AF duration of 85.9 months before hybrid ablation. 80 patients underwent successful thoracoscopic epicardial ablation, and 63 patients completed both epicardial and endocardial hybrid ablation. Complete conduction block was achieved in 89% (56/63) of patients after thoracoscopic endocardial ablation. At one-year, 87% (48/55) of patients were free from AF and 75% (41/55) were free from AF and off AAD. Unilateral epicardial ablation was associated with significantly shorter hospital length of stay compared to bilateral surgical approached (3.9 vs. 7.4 days, p = 0.003) with no difference in freedom from AF between groups at 1 year. Combined hybrid thoracoscopic and endovascular ablation for atrial fibrillation is effective for patients at high risk for recurrence after catheter ablation. The unilateral surgical approach is associated with a significantly shorter hospital stay with no appreciable effect on procedure success rates.