Surgical Ablation Not Superior To Catheter Ablation In Long-Standing Persistent Atrial Fibrillation

Healio Staff
23 Sep, 2020 ,

Researchers reported that Thoracoscopic surgical ablation for long-standing persistent atrial fibrillation was not superior to catheter ablation in freedom from arrhythmia of at least 30 seconds or burden reduction of at least 75%.  According to results from the CASA-AF trial presented at the virtual European Society of Cardiology Congress, catheter ablation resulted in better European Heart Rhythm Association scores for Atrial Fibrillation, more quality-adjusted life-years and lower total costs compared with surgical ablation.

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Thoracoscopic surgical ablation for long-standing persistent atrial fibrillation was not superior to catheter ablation in freedom from arrhythmia of at least 30 seconds or burden reduction of at least 75%, researchers reported.

According to results from the CASA-AF trial presented at the virtual European Society of Cardiology Congress, catheter ablation resulted in better European Heart Rhythm Association (EHRA) scores for AF, more quality-adjusted life-years and lower total costs compared with surgical ablation.

The findings were simultaneously published in the European Heart Journal.

“Long-standing persistent atrial fibrillation is a significant evidence gap in the literature, and this is well recognized in international guidelines. What is the optimal interventional first-line strategy for long-standing persistent AF is unknown,” Shouvik Haldar, MD(Res), MRCP, consultant cardiologist and electrophysiologist at the Royal Brompton and Harefield NHS Foundation Trust in London, said during a presentation. “Therefore, our study objective was to determine whether thoracoscopic surgical ablation was superior to catheter ablation as a first-line procedure in drug refractory, de novo, long-standing persistent AF patients.

“We found that thoracoscopic surgical ablation was not superior to catheter ablation in establishing and maintaining normal sinus rhythm in this group,” Haldar said. “We therefore recommend catheter ablation as the first-line interventional therapy for patients with symptomatic, long-standing persistent atrial fibrillation, refractory to drug therapy.”

Investigators randomly assigned 120 adult patients with long-standing persistent AF, EHRA score of more than 2 and left ventricular ejection fraction of at least 40% to undergo go surgical or catheter ablation. The primary endpoint was single procedure freedom from AF or atrial tachycardia no less than 30 seconds without antiarrhythmic drugs at 12 months. Secondary endpoints included differences in procedure-related adverse events, reduction in arrhythmia burden of at least 75%, EHRA score, QALYs and health care costs.