Haldar SK, et al. - This study appraised percutaneous catheter ablation (CA) vs electrophysiologically (EP) guided thoracoscopic surgical ablation (SA) as the first-line treatment strategy for long-standing persistent atrial fibrillation (LSPAF). The comparison between these two treatment procedures indicated that as a first-line strategy for LSPAF, meticulous electrophysiologically guided thoracoscopic SA may provide excellent single-procedure success rates, but there was an increased up-front risk of nonfatal complications.

Methods

• Researchers recruited 51 patients with de novo symptomatic LSPAF, of those, 26 underwent electrophysiologically guided thoracoscopic SA.
• An independent electrophysiologist intraoperatively tested conduction block for all lesions.
• Twenty-five consecutive patients underwent stepwise left atrial (LA) ablation in the CA group.
• The primary end point was single-procedure freedom from atrial fibrillation (AF) and atrial tachycardia (AT) lasting >30 seconds without antiarrhythmic drugs at 12 months.

Results

• Findings demonstrated that in the SA group vs the CA group, single- and multiprocedure freedom from AF/AT was higher: 19 of 26 patients (73%) vs 8 of 25 patients (32%) (P=.003) and 20 of 26 patients (77%) vs 15 of 25 patients (60%) (P=.19), respectively.
• Data also reported that testing of the SA lesion set by an electrophysiologist increased the success rate in achieving acute conduction block by 19%.
• Seven out of twenty-six patients (27%) in the SA group experienced complications vs 2 of 25 patients (8%) in the CA group (P=.07).