Catheter ablation vs. thoracoscopic surgical ablation in long-standing persistent atrial fibrillation: CASA-AF...

Area of Science:

• Cardiology
• Interventional Electrophysiology
• Surgical Innovation

Background:

• Long-standing persistent atrial fibrillation (LSPAF) presents treatment challenges with suboptimal outcomes from catheter ablation (CA).
• Thoracoscopic surgical ablation (SA) has emerged as a potentially effective alternative for atrial fibrillation (AF).

Purpose of the Study:

• To compare the efficacy and safety of thoracoscopic surgical ablation (SA) versus catheter ablation (CA) as a first-line interventional strategy for de novo long-standing persistent atrial fibrillation (LSPAF).

Main Methods:

• A multicentre randomized controlled trial involving 120 LSPAF patients randomized to SA or CA.
• Primary outcome: freedom from AF/atrial tachycardia (AT) without anti-arrhythmic drugs at 12 months.
• Secondary outcomes: clinical success, adverse events, symptom changes, quality-of-life scores, and cost-effectiveness.

Main Results:

• No significant difference in freedom from AF/AT between SA (26%) and CA (28%) at 12 months (P=0.83).
• Clinical success rates (≥75% AF/AT burden reduction) were similar: 67% for SA vs. 77% for CA (P=0.3).
• SA was associated with higher costs and fewer quality-adjusted life-years (QALYs) compared to CA (0.78 vs. 0.85, P=0.02).

Conclusions:

• Single-procedure thoracoscopic SA is not superior to catheter ablation for treating LSPAF.
• Catheter ablation demonstrated superior improvements in patient symptoms and quality-adjusted life-years during the 12-month follow-up.