Thoracoscopic Surgical Biatrial Ablation vs. Catheter Ablation in Patients with Persistent Atrial Fibrillation

Background. Limited randomized controlled studies showed that thoracoscopic surgical left atrial ablation was not superior to catheter ablation (CA) in patients with persistent atrial fibrillation (PerAF). Right atrium might play an important role in triggering and maintaining atrial fibrillation (AF) in patients with PerAF. This study aimed to compare the efficacy of thoracoscopic surgical biatrial ablation versus CA in patients with PerAF. Methods. Patients with PerAF underwent thoracoscopic surgical biatrial ablation or CA were included in this study. Propensity score matching (1 : 2) was applied to select patients in CA group and surgical ablation (SA) group. The primary endpoint was to compare the probability of freedom from atrial tachyarrhythmias between SA and CA. Atrial tachyarrhythmia recurrence was defined as any atrial tachyarrhythmias longer than 30 s documented by 24-hour Holter monitoring after the 3-month blanking period. Results. After propensity score matching, 51 patients in surgical biatrial ablation group and 102 patients in CA group were enrolled (mean left atrial diameter: 45.8 mm). The probability of freedom from atrial tachyarrhythmias on antiarrhythmia drugs was 62.7%, 60.6%, and 60.6% in SA group and 42.0%, 39.6%, and 36.7% in CA group at 12, 24, and 36 months, respectively (p = 0.011), and off antiarrhythmia drugs were 56.9%, 52.5%, and 52.5% in SA group and 36.0%, 31.4%, and 27.5% in CA group at 12, 24, and 36 months, respectively (p = 0.007). After adjustment of age, sex, left atrial diameter, and AF duration history, multivariable Cox regression analysis suggested that SA procedure was an independent factor to reduce the risk of atrial tachyarrhythmia recurrence (HR: 0.589, 95% CI 0.370-0.937, p = 0.025). Conclusion. Compared with CA, thoracoscopic surgical biatrial ablation might achieve superior effectiveness for patients with PerAF.