Dual Epicardial and Endocardial Procedure (DEEP) for Persistent or Longstanding Persistent Atrial Fibrillation

Area of Science:

• Cardiology
• Electrophysiology
• Minimally Invasive Procedures

Background:

• Persistent atrial fibrillation (PersAF) and longstanding persistent atrial fibrillation (LSPersAF) remain challenging to treat with endocardial catheter ablation (ECA), leading to undertreatment and suboptimal results.
• Patients with nonresponsive or advanced forms of AF require improved therapeutic options beyond conventional ECA.

Purpose of the Study:

• To evaluate the safety and effectiveness of a combined epicardial and endocardial ablation strategy with left atrial appendage exclusion for patients with PersAF/LSPersAF.
• To assess the outcomes of the Dual Epicardial and Endocardial Procedure (DEEP) in a prospective, multicenter trial.

Main Methods:

• The DEEP trial involved a two-stage hybrid ablation: an initial epicardial procedure including left atrial appendage exclusion, followed by endocardial catheter ablation (ECA) 91–121 days later.
• Patients were followed for 12 months, with effectiveness defined as freedom from atrial tachyarrhythmias and safety assessed by device/procedure-related serious adverse events within specified timeframes.

Main Results:

• The study enrolled 90 patients (mean age 63.4 years), with 83.3% having PersAF and 47.8% prior ECA.
• The primary safety endpoint showed a composite serious adverse event rate of 6.7%, meeting the safety goal.
• Primary effectiveness at 12 months was 71.8%, with 62.4% freedom from atrial tachyarrhythmias at 2 years.

Conclusions:

• A collaborative hybrid ablation approach combining epicardial and endocardial techniques is a safe and effective strategy for managing PersAF and LSPersAF.
• The DEEP procedure demonstrates promising results for patients who have not responded well to previous ablation attempts.