Transvenous Before Surgical Hybrid Procedure.

Area of Science:

• Cardiology
• Electrophysiology
• Medical Devices

Background:

• Persistent atrial fibrillation (PeAF) and long-standing persistent atrial fibrillation (LSPeAF) present significant management challenges.
• Conventional and hybrid ablation approaches have shown limited clinical success in treating these complex arrhythmias.

Purpose of the Study:

• To evaluate the efficacy and safety of a novel endocardial-before-epicardial ablation strategy for PeAF and LSPeAF.
• To describe the comprehensive endovascular and epicardial procedures involved in this approach.

Main Methods:

• A single-center study followed 40 patients with PeAF/LSPeAF over 12 months.
• The procedure involved an endovascular phase (pulmonary vein isolation, linear lesions, CFAE ablation) followed by an epicardial phase (GP ablation, posterior wall ablation, LAA ligation).
• All patients received implantable cardiac monitoring.

Main Results:

• All 40 patients maintained sinus rhythm at 12-month follow-up.
• Documented episodes of paroxysmal atrial arrhythmias did not persist after oral antiarrhythmic medication discontinuation.
• No procedural complications were reported.

Conclusions:

• The endocardial-before-epicardial approach significantly improved the management of PeAF and LSPeAF compared to conventional methods.
• This strategy demonstrates a promising, complication-free option for managing complex atrial arrhythmias.