Hybrid Totally Thoracoscopic Maze for Persistent Atrial Fibrillation: Early outcome analysis. 

OBJECTIVE:

Surgery for persistent atrial fibrillation (AF) has emerged as a beneficial adjunct when compared to catheter ablation alone.

Hybrid Totally Thoracoscopic Left atrial Maze (TTMAZE) combines epicardial and endocardial techniques and is reported to significantly improve outcomes. 

 

METHODS:

We present an analysis of 83 consecutive patients who underwent TTMAZE from November 2017 to February 2024 by a single surgeon. All patients underwent electrophysiologic three dimensional (3D) staged mapping. Preoperative workup included pulmonary function testing, echocardiography, and structural heart computed tomography to define the pulmonary anatomy and to exclude the presence of left atrial thrombus. 

 

RESULTS:

N= 83                            Median age 61 years

Males 77%                    Average weight of 97 kg. 

74 patients were in persistent or long-standing persistent AF. 

Presenting symptoms:    Fatigue (70%), Palpitations (55%), 

                                      Dizziness (19%) and Chest pain (9%). 

12.8% had previous TIA (Transient Ischemic attack) and 

2.6% had prior extracranial embolic episodes. 

Comorbidities: Hypertension (37%), Smoking (19%)       

                         Obstructive sleep apnoea (5%), 

                         Coronary artery disease (1.2%). 

The average hospital stay was 3.2 days.  

TIA was observed in 1.3%. 

Two patients required permanent pacemaker and two received direct cardioversion as inpatients. 

Patients were followed for a mean of 3.3 years by which stage anticoagulation (AC) had been ceased in 46% and 

antiarrhythmics (AA) ceased in 65%. 

Mapping was required in only 20 patients where additional endocardial touch up was performed most commonly in the roof and floor lines, followed by right superior pulmonary vein. 

Freedom  from AF (Single event >30 seconds) at most recent follow up was 87.9%

CONCLUSIONS:

This series with hybrid TTMAZE shows excellent outcomes with respect to symptom relief, cessation of AA and AC’s and excellent safely profile. Further long term follow up is in progress.

 

KEY REFERENCE:

Efficacy and safety of hybrid epicardial and endocardial ablation versus endocardial ablation in patients with persistent and longstanding persistent atrial fibrillation: a randomised, controlled trial. 

Nicolas Doll et al. EClinicalMedicine. 2023 Jun 22:61:102052.