Left atrial mechanical function following hybrid epicardial-endocardial vs endocardial catheter ablation: A randomized mechanistic trial.
Omar Ahmed, Jamie O'Driscoll, David Saliu et al.
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In 30 seconds
This randomized mechanistic trial compared left atrial mechanical function after hybrid epicardial-endocardial ablation (HA) versus endocardial catheter ablation (CA) in 50 patients with persistent atrial fibrillation. Echocardiography was assessed at baseline and 6 months; the primary analysis included 42 patients in sinus rhythm at follow-up. Reservoir strain, ejection fraction, and volume index improved in both groups (all P < .001), with no significant between-group differences after baseline adjustment. The findings showed no signal of worse mechanical recovery with HA compared with CA.
Key findings
- At follow-up, 84% of patients were in sinus rhythm: 88% after HA and 80% after CA (P = .70).
- Left atrial reservoir strain, ejection fraction, and volume index improved in both groups (all P < .001).
- No significant between-group differences in left atrial measures were detected after adjustment for baseline values.
Why it matters
Ablation strategies that isolate both the pulmonary veins and posterior wall may raise concern about effects on atrial mechanics. In this randomized comparison, measured left atrial function improved after either approach among patients in sinus rhythm at follow-up, without a detected disadvantage for the hybrid strategy. These findings inform assessment of mechanical recovery but do not establish equivalence beyond the outcomes and follow-up studied.
What to keep in mind
The primary mechanistic analysis was restricted to 42 patients in sinus rhythm at follow-up, and echocardiographic follow-up was at 6 months.