Surgical and hybrid atrial fibrillation ablation procedures

The purpose of this EP Wire is to survey clinical practice in this rapidly evolving field as the variety of surgical techniques and the heterogeneity of treated patients make the comparison of results and outcomes challenging.

Twenty-four European centres, all members of the EHRA EP research network, responded to this survey and completed the questions. Of the participating centres, 11 (46%) performed (irrespective of the technique) stand-alone surgical atrial fibrillation (AF) ablation in 2011. Seven hospitals (64%) performed totally thoracoscopic AF ablation procedures off-pump (in 20-100% of their cases). The most commonly used lesion set was only pulmonary vein isolation in five hospitals (46%). Eight centres (73%) performed validation of the surgical lesion set at the time of intervention. The most important indication for performing stand-alone, totally thoracoscopic surgical AF ablation in seven participating hospitals was failed catheter ablation. According to their definition of success, participating centres reported their success rate to be 10-100% for paroxysmal AF and 0-95% for (longstanding) persistent AF. The most frequently encountered complications during stand-alone, surgical AF ablation were pneumothorax and haemothorax in up to 10% of the cases.

This EP Wire survey shows a wide variation not only in indications for stand-alone, surgical AF ablation, but also in surgical techniques, lesion sets, follow-up, and outcome.