Interv Akut Kardiol. 2024;23(2-3):127-135

Randomized comparison of concomitant surgical treatment of persistent atrial fibrillation and hybrid approach -data from national multicentric SURHYB trial

Alan Bulava¹, Dan Wichterle², Aleš Mokráček¹, Pavel Osmančík³, Petr Budera², Petr Kačer³, Linda Vetešková⁴, Petr Němec⁴, Tomáš Skála⁵, Petr Šantavý⁵, Jan Chovančík⁶, Piotr Branny⁶, Vitalii Rizov⁷, Miroslav Kolesár⁷, Iva Šafaříková¹, Marian Rybář⁸

¹ Kardiocentrum Nemocnice České Budějovice a Zdravotně sociální fakulta Jihočeské univerzity v Českých Budějovicích

² Institut klinické a experimentální medicíny, Praha

³ Fakultní nemocnice Královské Vinohrady a 3. lékařská fakulta Univerzity Karlovy, Praha

⁴ Centrum kardiovaskulární a transplantační chirurgie, Brno

⁵ Fakultní nemocnice Olomouc a Univerzita Palackého v Olomouci

⁶ Nemocnice Agel, Třinec-Podlesí

⁷ Masarykova nemocnice v Ústí nad Labem

⁸ České vysoké učení technické v Praze, Kladno

Aims: To assess whether the timely pre-emptive radiofrequency (RF) catheter ablation would achieve higher freedom from atrial fibrillation (AF) or atrial tachycardia (AT) and be associated with better clinical outcomes than surgical ablation (CryoMaze) alone in patients with structural heart disease indicated for concomitant AF treatment.

Methods: The trial investigated patients with non-paroxysmal AF undergoing coronary artery bypass grafting and/or valve repair/replacement with mandatory concomitant CryoMaze procedure who were randomly assigned to undergo either RF catheter ablation three months post CryoMaze (Hybrid Group) or no further treatment (Surgery Group). The primary efficacy endpoint was the first recurrence of AF/AT without antiarrhythmic drugs as assessed by implantable cardiac monitors. The primary clinical endpoint was a composite of hospitalization for arrhythmia recurrence, worsening of heart failure, cardioembolic event, or major bleeding.

Results: We analyzed 113 and 116 patients in the Hybrid and Surgery Groups, respectively, with a median follow-up of 715 (IQR: 528–1 072) days. The primary efficacy endpoint was significantly reduced in the Hybrid Group (41.1 % vs 67.4 %, hazard ratio (HR)= 0.38, 95 % confidence interval (CI): 0.26–0.57, P < 0.001) as well as the primary clinical endpoint (19.9 % vs 40.1 %, HR = 0.51, 95 % CI: 0.29–0.86, P = 0.012). The trial groups did not differ in all-cause mortality (10.6 % vs. 8.6 %, HR = 1.17, 95 %CI: 0.51–2.71, P = 0.71). The major complications of catheter ablation were infrequent (1.9 %) and resulted in no clinical sequelae.

Conclusions: Concomitant CryoMaze alone leads to suboptimal arrhythmia control. Pre-emptively performed catheter ablation after the CryoMaze procedure was safe and associated with higher freedom from AF/AT and consequently improved clinical outcomes.

Keywords: atrial fibrillation, catheter ablation, concomitant atrial fibrillation ablation, hybrid ablation, Maze procedure

Received: August 19, 2024; Accepted: October 17, 2024; Published: December 12, 2024  Show citation