In Maastricht, the technology developed a serious option for patients with persistent atrial fibrillation
The hybrid ablation treatment developed at Maastricht UMC+ leads to persistent atrial fibrillation to better results than the standard treatment, the catheter ablation. About twice as many patients have no complaints after a year. In addition, the quality of life after one year is the same for both treatments, despite the fact that the hybrid ablation is a more serious procedure and requires more recovery time.
The research team, led by heart surgeon Bart Maesen and cardiologist Justin Luermans of the Heart + Vascular Center of Maastricht UMC + (MUMC +), recently published the results in the scientific journal JACC: Clinical Electrophysiology.
Atrial fibrillation
A patient with atrial fibrillation has an irregular and often accelerated heartbeat. This is caused by electrical stimuli occurring in several places in the atria, while they normally only arise in a specific place, the sinus node. As a result, too much stimulus often goes to the heart chambers, which therefore contract quickly and irregularly. Not all patients are equally affected by this, but common complaints are palpitations, sweating, dizziness, shortness of breath and fatigue. Some patients feel very limited in their daily lives.
Therapy
The cardiologist can prescribe medication to control atrial fibrillation. Depending on the success of medication and the severity of the arrhythmias, an ablation can also be chosen. During ablation, a doctor burns a number of points in the heart tissue to block the unnecessary electrical stimuli. This can be done in different ways: the cardiologist can apply the ablation points via the groin to the inside of the atria of the heart (catheter ablation). A heart surgeon can also place the ablation points on the outside of the atria via keyhole surgery. The disadvantage is that this sometimes has to be done several times, because, on the one hand, the effect of catheter ablation is often limited in a patient with long-term atrial fibrillation, and, on the other hand, keyhole surgery does not allow to check whether the stimuli are properly blocked.
Hybrid ablation
In 2010, cardiologists and heart surgeons at the MUMC+ therefore developed a method for performing both forms of ablation in one operation: hybrid ablation (HA). This required a new way of working, in which teams from two specialisms perform an intervention together. Since then, the hybrid ablation has been adopted by various centers in the world, but the MUMC+ is the only Dutch hospital where this HA is performed by the two teams in one operation. It is also major surgery, requiring 5 or 6 days of hospitalization and six months of rehabilitation. This is in contrast to a catheter ablation, for which patients are usually hospitalized for two days. Therefore, it was necessary to investigate whether the HA leads to better outcomes and a better quality of life.
Complaint-free and quality of life
Therefore, the researchers followed 43 patients who received treatment for persistent atrial fibrillation. On the basis of a lottery, part (19) received the HA, the rest a catheter ablation (KA). After one year, 89% of the HA group appeared to have no more complaints without taking medication, compared to 41% in the KA group. In addition, the quality of life of both patient groups appeared to be the same after one year. For example, it appears that the investment of the more serious operation yields a better result and the same quality of life.
Serious option
Heart surgeon Dr. Bart Maesen, together with colleague Elham Bidar and cardiologists Dr. Justin Luermans and Dr. Marisevi Chaldoupi, form the Maastricht HA team. Together they perform the operations and did the research. Maesen: ‘We are pleased to see that the hybrid ablation is leading to such good outcomes. It is not our intention that every patient with atrial fibrillation should now receive a hybrid ablation, but we think it is important that the treatment is discussed as a serious option. Then the patient can make a choice: a more serious operation with a higher success rate or a less invasive treatment that may be less successful and therefore has to be performed more often. We hope that hybrid ablation will also play a role in the new guidelines for persistent atrial fibrillation.’
Photo (vlnr.): dr. Bart Maesen, dr. Marisevi Chaldoupi, dr. Justin Luermans en dr. Elham Bidar.