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Title: | Thoracoscopic vs. catheter ablation for atrial fibrillation: long-term follow-up of the FAST randomized trial |
Author: | Castellà, Manuel Kotecha, Dipak van, Laar Charlotte Wintgens, Lisette Castillo, Yakir Kelder, Johannes Aragon, David Núñez, María Sandoval, Elena Casellas, Aina Mont Girbau, Lluís van Boven, Wim Jan Boersma, Lucas V. A. van Putte, Bart P. |
Keywords: | Fibril·lació auricular Mortalitat Atrial fibrillation Mortality |
Issue Date: | May-2019 |
Publisher: | Oxford University Press |
Abstract: | Aims: Our objectives were to compare effectiveness and long-term prognosis after epicardial thoracoscopic atrial fibrillation (AF) ablation vs. endocardial catheter ablation, in patients with prior failed catheter ablation or high risk of failure. Methods and results: Patients were randomized to thoracoscopic or catheter ablation, consisting of pulmonary vein isolation with optional additional lines (2007–2010). Patients were reassessed in 2016/2017, and those without documented AF recurrence underwent 7-day ambulatory electrocardiography. The primary rhythm outcome was recurrence of any atrial arrhythmia lasting >30 s. The primary clinical endpoint was a composite of death, myocardial infarction, or cerebrovascular event, analysed with adjusted Cox proportional hazard ratios (HRs). One hundred and 24 patients were randomized with 34% persistent AF and mean age 56 years. Arrhythmia recurrence was common at mean follow-up of 7.0 years, but substantially lower with thoracoscopic ablation: 34/61 (56%) compared with 55/63 (87%) with catheter ablation [adjusted HR 0.40, 95% confidence interval (CI) 0.25–0.64; P < 0.001]. Additional ablation procedures were performed in 8 patients (13%) compared with 31 (49%), respectively (P < 0.001). Eleven patients (19%) were on anti-arrhythmic drugs at end of follow-up with thoracoscopy vs. 24 (39%) with catheter ablation (P = 0.012). There was no difference in the composite clinical outcome: 9 patients (15%) in the thoracoscopy arm vs. 10 patients (16%) with catheter ablation (HR 1.11, 95% CI 0.40–3.10; P = 0.84). Pacemaker implantation was required in 6 patients (10%) undergoing thoracoscopy and 3 (5%) in the catheter group (P = 0.27). Conclusion: Thoracoscopic AF ablation demonstrated more consistent maintenance of sinus rhythm than catheter ablation, with similar long-term clinical event rates. |
Note: | Reproducció del document publicat a: http://dx.doi.org/ 10.1093/europace/euy325 |
It is part of: | Europace, 2019, vol. 21, num. 5, p. 746-753 |
URI: | http://hdl.handle.net/2445/132516 |
Related resource: | http://dx.doi.org/ 10.1093/europace/euy325 |
ISSN: | 1099-5129 |
Appears in Collections: | Articles publicats en revistes (ISGlobal) |
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