{"id":"313274ef6b89","type":"article","url":"https://hartvaat.nl/2024/10/03/geisoleerde-versus-hybride-thoracoscopische-ablatie-bij-af-korte-en-langetermijn/","title":"Geïsoleerde versus hybride thoracoscopische ablatie bij AF: korte en langetermijn","title_en":"Short- and long-term outcomes in isolated vs. hybrid thoracoscopic ablation in patients with atrial fibrillation: a systematic review and reconstructed individual patient data meta-analysis.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","doi":"10.1093/europace/euae232","source_url":"https://doi.org/10.1093/europace/euae232","authors":["Luca Aerts","Michal J Kawczynski","Elham Bidar","Justin G L Luermans","Sevasti-Maria Chaldoupi","Mark La Meir","Mariusz Kowalewski","Jos G Maessen","Samuel Heuts","Bart Maesen"],"significance":5,"published":"2024-10-03","source_date":"2024-10-03","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/ritmecontrole-af/","https://hartvaat.nl/kennis/antistolling/doac-versus-vka-keuze/"],"congress":"","summary_en":"A systematic review and individual patient data meta-analysis compared isolated thoracoscopic with hybrid thoracoscopic ablation for atrial fibrillation. The hybrid approach showed superior long-term freedom from atrial tachyarrhythmias, though it involves greater procedural complexity and careful patient selection.","created":"2026-07-03T10:31:14Z","updated":"2026-07-03T13:30:15Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Studie vergeleek geïsoleerde met hybride thoracoscopische ablatie bij AF. De hybride benadering toonde betere langetermijnresultaten maar is complexer. Patiëntenselectie is cruciaal.","abstract_original":"AIMS: Both isolated thoracoscopic and hybrid thoracoscopic atrial fibrillation (AF) ablation techniques have demonstrated favourable outcomes in the management of patients with (long-standing) persistent AF, as compared with catheter ablation. However, it is currently unknown whether there is a difference in short- and long-term outcomes when comparing these two minimally invasive surgical AF ablation procedures. Therefore, a systematic review and meta-analysis were performed to investigate these two techniques, with a specific emphasis on long-term freedom from atrial tachyarrhythmias (ATAs). METHODS AND RESULTS: A systematic search through PubMed, EMBASE, and the Cochrane Library databases was performed. All studies reporting on short-term outcomes were included in the meta-analysis. A pooled analysis of long-term freedom from ATA was performed based on Kaplan-Meier (KM) curve-derived individual patient data. Reconstructed individual time-to-event data were analysed in a multivariable Cox frailty model with adjustments for age, sex, type of AF, duration of AF history, and study variable (frailty term in the frailty Cox model). In total, 53 studies were included in the meta-analysis, encompassing 4950 patients. There were no differences in major short-term outcomes (mortality or stroke) between isolated thoracoscopic and hybrid thoracoscopic ablation. A total of 18 studies reported KM curves for long-term freedom from ATA, comprising 2038 patients. Adjusted analysis revealed that hybrid ablation was significantly associated with greater freedom from ATA [adjusted hazard ratio (aHR) = 0.59, 95% confidence interval (CI): 0.43-0.83, P < 0.001] compared with isolated thoracoscopic ablation. Additionally, older age (aHR = 1.07, 95% CI: 1.03-1.12, P = 0.002) and a higher percentage of male patients (aHR = 1.02, 95% CI: 1.01-1.03, P < 0.001) were significantly associated with lower long-term freedom from ATA recurrence. CONCLUSION: Hybrid thoracoscopic AF ablation is associated with a greater long-term freedom from ATA when compared with isolated thoracoscopic ablation, without differences in complications."}