Nicolas Doll, MD, PhD

The primary results of the CEASE-AF trial demonstrated that hybrid ablation—epicardial plus endocardial ablation—was superior to endocardial ablation alone in reducing atrial arrhythmias in patients with persistent and longstanding persistent atrial fibrillation (AF), without increasing adverse events.

A total of 170 patients with persistent AF and enlarged left atria or longstanding persistent AF in the prospective CEASE-AF trial were randomized 2:1 to hybrid ablation or endocardial catheter ablation. In the hybrid ablation arm, patients first underwent epicardial ablation, followed by a 90-day blanking period and subsequent endocardial ablation. The primary efficacy outcome was the freedom from AF, atrial flutter, or atrial tachycardia greater than 30 seconds through 12 months. Nicolas Doll, MD, PhD, presented the primary results of the trial at the 2023 European Heart Rhythm Association (EHRA) Congress, held from April 16 to 18, in Barcelona, Spain.¹

Of total participants, 71.6% in the hybrid arm and 39.2% of those in the endocardial ablation arm, met the primary endpoint, representing a significant difference in efficacy between the two study arms (P<0.001). Furthermore, the rates of “repeat ablations” (4.2% vs 35.3%; P<0.001) and cardioversions (11.6% vs 25.5%; P=0.037) were lower in the intervention arm. Notably, there was no significant difference in terms of safety. The composite complication rate at 30 days post-index and 30 days post-second stage plus repeat ablation were 7.8% in the intervention arm and 5.8% in the control arm (P=0.75). Dr. Doll stressed that the success of an epicardial-endocardial approach emphasises the role of a collaborative heart team approach in the treatment of non-paroxysmal AF.

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