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.