Hybrid ablation of atrial fibrillation: A unilateral left‐sided thoracoscopic approach

BACKGROUND: Hybrid ablation (HA) of atrial fibrillation (AF) combines minimally invasive thoracoscopic epicardial ablation with transvenous endocardial electrophysiologic validation and touch‐up of incomplete epicardial lesions if needed. While studies have reported on a bilateral thoracoscopic HA approach, data on a unilateral left‐sided approach are scarce. AIM: To evaluate the efficacy and safety of a unilateral left‐sided thoracoscopic approach. METHODS: Retrospective analysis of a prospectively gathered cohort of all consecutive patients undergoing a unilateral left‐sided HA for AF between 2015 and 2018 in the Maastricht University Medical Centre. RESULTS: One‐hundred nineteen patients were analyzed (mean age 64 ± 8, 28% female, mean body mass index 28 ± 4 kg/m(2), median CHA(2)DS(2)‐VASc Score 2 [1–3], [longstanding]‐persistent AF 71%, previous catheter ablation 44%). In all patients, a unilateral left‐sided HA consisting of pulmonary vein (PV) isolation, posterior left atrial (LA) wall isolation, and LA appendage exclusion was attempted. Epicardial (n = 59) and/or endocardial validation (n = 81) was performed and endocardial touch‐up was performed in 33 patients. Major peri‐operative complications occurred in 5% of all patients. After 12 and 24 months, the probability of being free from supraventricular tachyarrhythmia recurrence was 80% [73–87] and 67% [58–76], respectively, when allowing antiarrhythmic drugs. CONCLUSION: Unilateral left‐sided hybrid AF ablation is an efficacious and safe approach to treat patients with paroxysmal and (longstanding) persistent AF. Future studies should compare a unilateral with a bilateral approach to determine whether a left‐sided approach is as efficacious as a bilateral approach and allows for less complications.