Results
The baseline characteristics of the 276 patients (197 CB PVIs with an
average age of 64.2 ± 10.6 years and 79 hybrid procedures with an
average age of 61.4 ± 8.1 years) did have some significant differences
among the two subgroups (table 1). Both cohorts were composed of mostly
men, representing 66.5% of the CB PVI group and 83.5% of the hybrid
group (p=<0.01). PAF represented 74.1% of the CB PVI group
and 41.8% of the hybrid group (p=<0.001) while persistent AF
was encountered in 18.3% of the CB PVI group vs. 45.6% of the hybrid
group. LSPAF patients composed 1.0% of the CB PVI group and 12.7% of
the hybrid group (p=<0.001). Generally, the CB PVI group had a
much shorter duration of AF (4.4 ± 4.3 years) when compared to the
hybrid group 9.4 ± 7.9 years (p=>0.001).
Both groups, on average had preserved LVEF.
CHA2DS2-VASc scores were significantly
higher in the CB PVI group (2.3 ± 1.6) when compared to the hybrid group
(1.7 ± 1.3) (p=0.01). The hybrid group more frequently had both prior
ablation and prior cardioversions (58.2% and 83.5% respectively) in
comparison to the CB PVI group (18.3% and 44.7% respectively) (p =
<0.001). There was no significant difference in the prevalence
of the following comorbidities: heart failure, hypertension, diabetes
mellitus, stroke or transient ischemic attack, and coronary/peripheral
artery disease. Regarding primary outcomes, freedom from arrhythmia
post-procedure at 6 months (CB PVI: 82.4% vs. hybrid: 85.1%), 12
months (CB PVI: 74.5% vs. hybrid: 66.5%), 24 months (CB PVI: 64.5%
vs. Hybrid: 61.4%), and 36 months (CB PVI: 55.2% vs. Hybrid: 50.4%),
was similar in both groups. Some patients were able to be followed
through 48 months and again, arrhythmia occurrence was similar in both
arms (CB PVI: 49.5% vs. Hybrid: 39.2%) (figure 1).
As listed in table 2, there were two procedure-related perioperative
complications in the CB PVI group and three in the hybrid group
(p=0.14). AAD utilization is listed in table 3. Class I AAD utilization
at discharge occurred in 38 (19.3%) patients in the CB PVI group and 5
(6.3%) in the hybrid convergent group (p=0.01). CB PVI Class I AAD
utilization at 12 months occurred in 14 (9.0) patients versus 0 patients
for hybrid convergent (0.004). There was no additional AAD utilization
difference noted at discharge, 12, or 36 months.