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Hybrid ablation: a team operation with better outcomes

The hybrid ablation treatment developed at Maastricht UMC+ leads to better results in persistent atrial fibrillation than the standard treatment, catheter ablation. About twice as many patients no longer have symptoms after a year. Moreover, the quality of life after one year is the same for both treatments, despite the fact that hybrid ablation is a heavier procedure and requires more recovery time.

The research team, led by cardiac surgeon Bart Maesen and cardiologist Justin Luermans of the Heart+Vascular Center of Maastricht UMC+ (MUMC+), recently published the results in the scientific journal JACC: Clinical Electrophysiology.

Atrial fibrillation

A patient with atrial fibrillation has an irregular and often accelerated heartbeat. This is caused by electrical impulses occurring in several places in the atria, whereas normally they occur only in a specific place, the sinus node. As a result, too many stimuli also often travel to the ventricles, causing them to contract rapidly and irregularly. Patients are not all affected equally, but common symptoms include palpitations, sweating, dizziness, shortness of breath and fatigue. Some patients feel very limited in their daily lives.

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dr. Bart Maesen, dr. Marisevi Chaldoupi, dr. Justin Luermans en dr. Elham Bidar.

Treatment

The cardiologist may prescribe medication to control atrial fibrillation. Depending on the success of medication and the severity of the arrhythmias, ablation may also be chosen. In ablation, a doctor burns a number of dots into the heart tissue to block the unnecessary electrical stimuli. This can be done in several ways: the cardiologist can apply the ablation points through the groin to the inside of the atria of the heart (catheter ablation). Alternatively, a cardiac surgeon can apply the ablation points on the outside of the atria through keyhole surgery. The disadvantage is that this sometimes has to be done several times because in a patient with long-term atrial fibrillation the effect of catheter ablation is often limited. In addition, keyhole surgery does not allow for a good check that the stimuli are properly blocked.

Hybrid ablation

In 2010, cardiologists and cardiac surgeons at MUMC+ therefore developed a method to perform both forms of ablation in one operation: hybrid ablation (HA). This required a new way of working, with teams from two specialties performing an operation together. Since then, hybrid ablation has been adopted by several centers around the world, but the MUMC+ is the only Dutch hospital where this HA is performed by the two teams in one operation. It is a major surgery, requiring a hospital stay of 5 or 6 days and six months of rehabilitation. This is in contrast to catheter ablation, for which patients are usually hospitalized for two days. Therefore, it was necessary to investigate whether the HA leads to better outcomes and quality of life.

Complaint-free and quality of life

The researchers followed 43 patients receiving treatment for persistent atrial fibrillation. Based on lottery, some (19) received the HA, the rest received catheter ablation (KA). After one year, 89% of the HA group were found to have no more symptoms without medication use, compared to 41% in the KA group. Moreover, the quality of life of both patient groups was found to be similar after one year. Thus, it appears that the investment of the more severe surgery provides a better outcome and the same quality of life.

Valid option

Cardiac surgeon Dr. Bart Maesen forms the Maastricht HA team together with colleague Elham Bidar and cardiologists Dr. Justin Luermans and Dr. Marisevi Chaldoupi. Together they perform the operations and did the research. Maesen: "We are happy to see that hybrid ablation leads to good outcomes. It is not our intention that every patient with atrial fibrillation should now receive hybrid ablation, but we think it is important that the treatment is discussed as a serious option. Then the patient can make their own choice: a more serious surgery with a higher success rate or a less invasive treatment that may be less successful and therefore need to be performed more often. We hope that hybrid ablation will also get a role in the new guidelines for persistent atrial fibrillation.

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