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Updated: Feb 19, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Catheter ablation vs electrophysiologically guided thoracoscopic surgical ablation in long-standing persistent atrial
Shouvik K Haldar1, David G Jones1, Toufan Bahrami1
1Heart Rhythm Centre, Royal Brompton & Harefield National Health Service Foundation Trust, Imperial College London, London, United Kingdom.
Insights
Thoracoscopic surgical ablation (SA) shows higher success rates for long-standing persistent atrial fibrillation (LSPAF) than catheter ablation (CA) as a first-line treatment. However, SA involves a greater initial risk of nonfatal complications.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Outcomes for catheter ablation (CA) in long-standing persistent atrial fibrillation (LSPAF) are often suboptimal.
- Thoracoscopic surgical ablation (SA) presents an alternative treatment for this challenging patient group.
Purpose of the Study:
- To compare the efficacy of electrophysiologically (EP) guided thoracoscopic SA versus percutaneous CA as a first-line therapy for LSPAF.
Main Methods:
- Fifty-one patients with symptomatic LSPAF were randomized into two groups: 26 underwent EP-guided thoracoscopic SA, and 25 underwent stepwise LA CA.
- Intraoperative testing of SA lesions by an independent electrophysiologist was performed.
- The primary endpoint was single-procedure freedom from atrial fibrillation (AF) or atrial tachycardia (AT) at 12 months.
Main Results:
- Single-procedure freedom from AF/AT was significantly higher in the SA group (73%) compared to the CA group (32%) (P = .003).
- Multiprocedure freedom from AF/AT was 77% for SA versus 60% for CA (P = .19).
- Intraoperative EP testing improved acute conduction block in SA by 19%. Complications occurred in 27% of SA patients versus 8% of CA patients (P = .07).
Conclusions:
- Electrophysiologically guided thoracoscopic SA may offer superior single-procedure success rates for LSPAF compared to CA when used as a first-line strategy.
- This approach, however, is associated with a higher upfront risk of nonfatal complications.
Background:
Catheter ablation (CA) outcomes for long-standing persistent atrial fibrillation (LSPAF) remain suboptimal. Thoracoscopic surgical ablation (SA) provides an alternative approach in this difficult to treat cohort.
Objective:
To compare electrophysiological (EP) guided thoracoscopic SA with percutaneous CA as the first-line strategy in the treatment of LSPAF.
Methods:
Fifty-one patients with de novo symptomatic LSPAF were recruited. Twenty-six patients underwent electrophysiologically guided thoracoscopic SA. Conduction block was tested for all lesions intraoperatively by an independent electrophysiologist. In the CA group, 25 consecutive patients underwent stepwise left atrial (LA) ablation. 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:
Single- and multiprocedure freedom from AF/AT was higher in the SA group than in the CA group: 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. Testing of the SA lesion set by an electrophysiologist increased the success rate in achieving acute conduction block by 19%. In the SA group, complications were experienced by 7 of 26 patients (27%) vs 2 of 25 patients (8%) in the CA group (P = .07).
Conclusion:
In LSPAF, meticulous electrophysiologically guided thoracoscopic SA as a first-line strategy may provide excellent single-procedure success rates as compared with those of CA, but there is an increased up-front risk of nonfatal complications.
