Impact of 'hybrid therapy' on long-term rhythm control and arrhythmia related hospitalizations in patients with drug-refractory persistent and permanent atrial fibrillation.

摘要

BACKGROUND: Recently, a "hybrid therapy" strategy has been used for successful rhythm control in persistent and permanent atrial fibrillation (AF) patients. The impact of this strategy on arrhythmia recurrences and subsequent AF related hospitalizations are unknown. MATERIALS AND METHODS: Forty-seven patients (66 +/- 10 years) with symptomatic persistent (N = 26) or permanent (N = 21) AF underwent hybrid therapy linear right atrial ablation and implantation of pacemaker or atrioventricular defibrillator (AVICD) capable of continuous right atrial pacing with previously ineffective antiarrhythmic drug therapy for AF prevention. Device data-logs were used to monitor AF recurrences. RESULTS: Freedom from permanent AF was 97, 90, and 83% at 6 months, 2 and 3 years, respectively. Sixteen patients (34%) had no recurrent AF after "hybrid therapy." Thirty-one patients (66%) had a total of 55 AF recurrences (mean 1.8 per patient). There was a significant reduction in the mean AF related hospitalizations (from 3.5 +/- 2.8 to 0.57 +/- 1.1 per patient), cardioversion hospitalizations (from 3.5 +/- 2.2 to 0.38 +/- 0.5 per patient) and DC cardioversions (from 3.1 +/- 3.9 to 0.7 +/- 0.5 per patient) after hybrid therapy compared to event rates before therapy (p < 0.05 for all). CONCLUSIONS: Rhythm control improves significantly with hybrid therapy in patients with persistent and permanent AF refractory to drugs and cardioversion therapy. This improvement is associated with a significant reduction in AF related hospitalizations and need for cardioversion therapy.