{"id":"4329e90649a1","type":"article","url":"https://hartvaat.nl/2026/05/11/thoracoscopische-af-ablatie-met-bipolaire-clamp-5-jaars-ritmevrijheid-52-met-ant/","title":"Thoracoscopische AF-ablatie met bipolaire clamp: 5-jaars ritmevrijheid 52% met antiaritmica — multicenter register","title_en":"","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":[],"journal":"European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery","doi":"10.1093/ejcts/ezag161","source_url":"https://doi.org/10.1093/ejcts/ezag161","authors":["Luca Aerts","Michal J Kawczynski","Niels J Verberkmoes","Thomas Van Brakel","Justin G L M Luermans","Samuel Heuts","Eva Verbeek","Ricardo Cocchieri","Sacha P Salzberg","Henri Gruwez","Herbert Gutermann","Laurent Pison","Dmitry Elesin","Alexander Bogachev-Prokophiev","Oleg Shelest","Alexandr Troitskiy","Robert Khabazov","Aleksander Zotov","Bart Maesen"],"significance":6,"published":"2026-06-23","source_date":"2026-05-11","image":"","kennis":["https://hartvaat.nl/kennis/atriumfibrilleren/elektrisch-remodellering-atrium/","https://hartvaat.nl/kennis/atriumfibrilleren/ecg-herkenning-af/"],"congress":"","summary_en":"Retrospective multicenter registry of 678 patients undergoing isolated or hybrid thoracoscopic atrial fibrillation (AF) ablation with a bipolar irrigated radiofrequency clamp (Gemini Clamp) between 2010 and 2023. Most had longstanding persistent AF (66.7%, mean AF duration 61 months), and 33.3% had prior catheter ablation. Freedom from atrial tachyarrhythmias (allowing class I/III antiarrhythmic use) was 82.3% at 1 year, 71.5% at 3 years, and 52.4% at 5 years. Without antiarrhythmics, this declined from 71.7% (year 1) to 44.2% (year 5), underscoring AF's progressive nature. Women presented with greater comorbidity and higher CHA2DS2-VA scores, but long-term rhythm outcomes did not differ by sex or by paroxysmal vs non-paroxysmal AF. Complication rates were low. Variability in arrhythmia-detection methods across centres may have affected outcomes.","created":"2026-07-03T10:33:06Z","updated":"2026-07-03T18:39:36Z","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":"Retrospectief multicenter register van 678 patiënten die tussen 2010 en 2023 een geïsoleerde of hybride thoracoscopische atriumfibrilleren-ablatie (AF-ablatie) ondergingen met een bipolaire geïrrigeerde radiofrequentie-clamp (Gemini Clamp). Meerderheid had longstanding-persisterende AF (66,7%, gemiddelde AF-duur 61 maanden), en 33,3% had eerdere katheterablatie. Vrijheid van atriale tachy-aritmieën (met toegestaan gebruik van klasse I/III antiaritmica) was 82,3% na 1 jaar, 71,5% na 3 jaar en 52,4% na 5 jaar. Zonder antiaritmica daalde dat van 71,7% (jaar 1) naar 44,2% (jaar 5), wat het progressieve karakter van AF onderstreept. Vrouwen presenteerden zich met meer comorbiditeit en hoger CHA2DS2-VA-score, maar lange-termijn ritme-uitkomsten verschilden niet tussen mannen en vrouwen, of tussen paroxysmaal versus niet-paroxysmaal AF. De complicatie-incidentie was laag. Variabiliteit in detectiemethodes tussen centra kan de uitkomsten hebben beïnvloed.","abstract_original":"OBJECTIVES: This study aimed to evaluate the long-term efficacy and safety of isolated and hybrid thoracoscopic atrial fibrillation (AF) ablation using a bipolar irrigated radiofrequency clamp in a multicentre registry. METHODS: A retrospective multicentre registry of patients undergoing AF ablation using the bipolar clamp was conducted over the past 13 years (2010-2023). The primary efficacy outcome was freedom of atrial tachyarrhythmias (ATAs), with and without the use of Class I/III antiarrhythmic drugs (AADs). Antiarrhythmic drug use during follow-up was not uniformly documented across centres. The primary safety outcome was the rate of periprocedural complications. RESULTS: The cohort of 678 patients consisted of a minority of female patients (17.4%), with most patients having longstanding persistent AF (LSPAF) (66.7%), a mean duration of 61 months of AF duration and 33.3% had undergone prior catheter ablation. Freedom from ATA while allowing Class I/III AAD use was 82.3%, 71.5%, and 52.4% at 1, 3, and 5 years, respectively. Freedom from ATA off Class I/III AAD declined from 71.7% at 1 year to 44.2% at 5 years, underscoring the progressive nature of AF and the need for long-term rhythm strategies. Women presented with a more advanced cardiovascular risk profile than men, including older age (60.3 vs 57.3 years), higher CHA2DS2-VA-scores, and more comorbidities. Despite these differences, there were no significant sex-based differences in long-term ATA freedom. There were no significant unadjusted differences in long-term ATA freedom between paroxysmal AF (PAF) and non-PAF. Major complication rate was low. CONCLUSIONS: Isolated and hybrid thoracoscopic AF ablation using the Gemini Clamp demonstrated favourable outcomes with a low complication rate. However, variability in ATA detection methods among centres may have influenced the primary outcome and should be considered when interpreting long-term efficacy results. CLINICAL TRIAL REGISTRY NUMBER: METC-number 2022-3561."}