Related Experiment Video
Updated: Aug 11, 2025
Robotic Ablation of Atrial Fibrillation
Published on: May 29, 2015
Hybrid Ablation Versus Repeated Catheter Ablation in Persistent Atrial Fibrillation: A Randomized Controlled Trial
Claudia A J van der Heijden1, Vanessa Weberndörfer2, Mindy Vroomen3
1Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.
Insights
Hybrid ablation (HA) offers superior outcomes compared to catheter ablation (CA) for persistent atrial fibrillation (AF). This study found HA significantly increased freedom from atrial tachyarrhythmias, demonstrating its efficacy and safety for AF treatment.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Interventions
Background:
- Catheter ablation (CA) is effective for paroxysmal atrial fibrillation (AF) but less so for persistent AF (persAF).
- Hybrid ablation (HA) combines epicardial and endocardial approaches for improved persAF outcomes.
Purpose of the Study:
- To compare the effectiveness and safety of HA versus CA in a randomized controlled trial.
- To evaluate HA as a superior treatment for patients with persistent AF.
Main Methods:
- A prospective, unblinded, randomized controlled trial involving 41 ablation-naive patients with persistent AF.
- Patients were randomized to either HA (n=19) or CA (n=22).
- Procedures included pulmonary vein isolation, posterior left atrial wall isolation, and cavotricuspid isthmus ablation if needed. Efficacy was assessed by freedom from atrial tachyarrhythmias off antiarrhythmic drugs at 12 months.
Main Results:
- Freedom from atrial tachyarrhythmias off antiarrhythmic drugs at 12 months was significantly higher in the HA group (89%) compared to the CA group (41%; P=0.002).
- Adverse events were comparable between groups (HA: 21%, CA: 14%; P=0.685).
- Specific complications included pericarditis and arteriovenous fistula in the HA group, and femoral artery bleeding in the CA group. No deaths or strokes occurred.
Conclusions:
- Hybrid ablation is an effective and safe procedure for treating persistent atrial fibrillation.
- HA demonstrates superior outcomes compared to catheter ablation in patients with persistent AF.
- The HARTCAP-AF trial (NCT02441738) supports HA as a preferred treatment modality for persistent AF.
Background:
Although catheter ablation (CA) is successful for the treatment of paroxysmal atrial fibrillation (AF), results are less satisfactory in persistent AF. Hybrid ablation (HA) results in better outcomes in patients with persistent atrial fibrillation (persAF), as it combines a thoracoscopic epicardial and transvenous endocardial approach in a single procedure.
Objectives:
The purpose of this study was to compare the effectiveness and safety of HA with CA in a prospective, superiority, unblinded, randomized controlled trial.
Methods:
Forty-one ablation-naive patients with (long-standing)-persAF were randomized to HA (n = 19) or CA (n = 22) and received pulmonary vein isolation, posterior left atrial wall isolation and, if needed, a cavotricuspid isthmus ablation. The primary efficacy endpoint was freedom from any atrial tachyarrhythmia >5 minutes off antiarrhythmic drugs after 12 months. The primary and secondary safety endpoints included major and minor complications and the total number of serious adverse events.
Results:
After 12 months, the freedom of atrial tachyarrhythmias off antiarrhythmic drugs was higher in the HA group compared with the CA group (89% vs 41%, P = 0.002). There was 1 pericarditis requiring pericardiocentesis and 1 femoral arteriovenous-fistula in the HA group. In the CA arm, 1 bleeding from the femoral artery occurred. There were no deaths, strokes, need for pacemaker implantation, or conversions to sternotomy, and the number of (serious) adverse events was comparable between groups (21% vs 14%, P = 0.685).
Conclusions:
Hybrid AF ablation is an efficacious and safe procedure and results in better outcomes than catheter ablation for the treatment of patients with persistent AF. (Hybrid Versus Catheter Ablation in Persistent AF [HARTCAP-AF]; NCT02441738).
