{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,6,27]],"date-time":"2025-06-27T05:23:01Z","timestamp":1751001781877,"version":"3.37.3"},"reference-count":18,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2021,3,24]],"date-time":"2021-03-24T00:00:00Z","timestamp":1616544000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"Alfieri-Heart-Foundation"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,7,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>\u2002<\/jats:title>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>To assess by a continuous implantable rhythm monitoring (ILR) the mid-term outcomes of a staged-hybrid approach for patients with persistent\/long-standing persistent atrial fibrillation (AF) and dilated atria.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>Fifty patients [age 57 (standard deviation, SD: 8.3), previous catheter ablation 66%, AF history 6.5 (2\u201312) years, left ventricular ejection fraction 56 (SD: 7.9)%, left atrial volume index 44 (38\u201356) ml\/m2] with persistent (44%) or long-standing persistent (56%) AF, underwent a 2-staged hybrid ablation (thoracoscopic epicardial procedure with Cobra-Fusion system and transcatheter Rhythmia mapping with endocardial touch-up of gaps). All patients received an ILR.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>No hospital deaths and no stroke occurred. Follow-up was 98% complete [median 22 (11\u201334) months]. The 2-year arrhythmia-free survival off class I\u2013III antiarrhythmic drugs\/electrical cardioversion\/redo catheter ablation and the arrhythmia control (maintenance of sinus rhythm with or without antiarrhythmic drugs\/electrical cardioversion) were 65 (SD: 7.1)% and 82 (SD: 5.8)%, respectively. The occurrence of AF in the blanking period was identified as an independent predictor of AF recurrence (odds ratio 26.6, 95% confidence interval 5.3, 132.3; P\u2009&amp;lt;\u20090.001). At longitudinal analysis, the predicted prevalence of sinus rhythm and sinus rhythm off class I\u2013III antiarrhythmic drugs\/electrical cardioversion\/redo catheter ablation was 82% and 69% at 2\u2009years, respectively. Among patients with recurrence, 50% had short-lasting asymptomatic episodes, identified only by ILR monitoring. The proportion of patients with AF burden \u22641% was 82% and 91% at 1 and 2\u2009years, respectively, and in these cases, left atrial volume index decreased from 46 (SD: 12) ml\/m2 to 41 (SD: 11) ml\/m2 (P\u2009=\u20090.026).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>A staged hybrid approach yields promising results in selected patients with persistent\/long-standing persistent AF and dilated left atrium who are at very high risk of AF recurrence. The use of ILR in this setting should become a standard to optimize patient management.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejcts\/ezab064","type":"journal-article","created":{"date-parts":[[2021,1,27]],"date-time":"2021-01-27T20:09:32Z","timestamp":1611778172000},"page":"222-230","source":"Crossref","is-referenced-by-count":3,"title":["Heart-team hybrid approach to persistent atrial fibrillation with dilated atria: the added value of continuous rhythm monitoring"],"prefix":"10.1093","volume":"60","author":[{"given":"Elisabetta","family":"Lapenna","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San-Raffaele University, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manuela","family":"Cireddu","sequence":"additional","affiliation":[{"name":"Department of Cardiac-Electrophysiology and Arrhythmia, IRCCS San Raffaele Hospital, Vita-Salute San-Raffaele University, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Teodora","family":"Nisi","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San-Raffaele University, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefania","family":"Ruggeri","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San-Raffaele University, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0081-6232","authenticated-orcid":false,"given":"Benedetto","family":"Del Forno","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San-Raffaele University, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5186-1976","authenticated-orcid":false,"given":"Fabrizio","family":"Monaco","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Anesthesia and Intensive Care, IRCCS San Raffaele Hospital, Vita-Salute San-Raffaele University, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marta","family":"Bargagna","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San-Raffaele University, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"D\u2019Angelo","sequence":"additional","affiliation":[{"name":"Department of Cardiac-Electrophysiology and Arrhythmia, IRCCS San Raffaele Hospital, Vita-Salute San-Raffaele University, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Caterina","family":"Bisceglia","sequence":"additional","affiliation":[{"name":"Department of Cardiac-Electrophysiology and Arrhythmia, IRCCS San Raffaele Hospital, Vita-Salute San-Raffaele University, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simone","family":"Gulletta","sequence":"additional","affiliation":[{"name":"Department of Cardiac-Electrophysiology and Arrhythmia, IRCCS San Raffaele Hospital, Vita-Salute San-Raffaele University, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eustachio","family":"Agricola","sequence":"additional","affiliation":[{"name":"Cardiovascular-Imaging Unit, IRCCS San Raffaele Hospital, Vita-Salute San-Raffaele University, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alessandro","family":"Castiglioni","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San-Raffaele University, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1065-8052","authenticated-orcid":false,"given":"Ottavio","family":"Alfieri","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San-Raffaele University, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9329-7437","authenticated-orcid":false,"given":"Michele","family":"De Bonis","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San-Raffaele University, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Paolo","family":"Della Bella","sequence":"additional","affiliation":[{"name":"Department of Cardiac-Electrophysiology and Arrhythmia, IRCCS San Raffaele Hospital, Vita-Salute San-Raffaele University, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,3,24]]},"reference":[{"key":"2021080208043589800_ezab064-B1","doi-asserted-by":"crossref","first-page":"1921","DOI":"10.1016\/j.jacc.2012.04.060","article-title":"Catheter ablation of long-standing persistent atrial fibrillation: 5-year outcomes of the Hamburg Sequential Ablation Strategy","volume":"60","author":"Tilz","year":"2012","journal-title":"J Am Coll Cardiol"},{"key":"2021080208043589800_ezab064-B2","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/j.athoracsur.2019.05.061","article-title":"Long-term outcomes of stand-alone Maze IV for persistent or long-standing persistent atrial fibrillation","volume":"109","author":"Lapenna","year":"2020","journal-title":"Ann Thorac Surg"},{"key":"2021080208043589800_ezab064-B3","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1093\/europace\/euy303","article-title":"Early experience of thoracoscopic vs catheter ablation for atrial fibrillation","volume":"21","author":"Pearman","year":"2019","journal-title":"Europace"},{"key":"2021080208043589800_ezab064-B4","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1093\/europace\/eux274","article-title":"2017 HRS\/EHRA\/ECAS\/APHRS\/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation","volume":"20","author":"Calkins","year":"2018","journal-title":"Europace"},{"key":"2021080208043589800_ezab064-B5","doi-asserted-by":"crossref","first-page":"1550","DOI":"10.1016\/j.athoracsur.2016.04.018","article-title":"Long-term success for the convergent atrial fibrillation procedure: 4-year outcomes","volume":"102","author":"Gersak","year":"2016","journal-title":"Ann Thorac Surg"},{"key":"2021080208043589800_ezab064-B6","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1093\/icvts\/ivx248","article-title":"Two-staged hybrid ablation of non-paroxysmal atrial fibrillation: clinical outcomes and functional improvements after 1 year","volume":"26","author":"Budera","year":"2018","journal-title":"Interact CardioVasc Thorac Surg"},{"key":"2021080208043589800_ezab064-B7","doi-asserted-by":"crossref","first-page":"740","DOI":"10.1093\/ejcts\/ezx162","article-title":"European prospective multicentre study of hybrid thoracoscopic and transcatheter ablation of persistent atrial fibrillation: the HISTORIC-AF trial","volume":"52","author":"Muneretto","year":"2017","journal-title":"Eur J Cardiothorac Surg"},{"key":"2021080208043589800_ezab064-B8","first-page":"58","article-title":"Midterm clinical outcomes of concomitant thoracoscopic epicardial and transcatheter endocardial ablation for persistent and long-standing persistent atrial fibrillation: a single-centre experience","volume":"19","author":"de Asmundis","year":"2017","journal-title":"Europace"},{"key":"2021080208043589800_ezab064-B9","doi-asserted-by":"crossref","first-page":"655","DOI":"10.1093\/europace\/euy191","article-title":"Acute safety, effectiveness, and real-world clinical usage of ultra-high density mapping for ablation of cardiac arrhythmias: results of the TRUE-HD study","volume":"21","author":"Hindricks","year":"2019","journal-title":"Europace"},{"key":"2021080208043589800_ezab064-B10","doi-asserted-by":"crossref","first-page":"i26","DOI":"10.1093\/ejcts\/ezy117","article-title":"Three-year follow-up of hybrid ablation for atrial fibrillation","volume":"53","author":"Maesen","year":"2018","journal-title":"Eur J Cardiothorac Surg"},{"key":"2021080208043589800_ezab064-B11","doi-asserted-by":"crossref","first-page":"1246","DOI":"10.1016\/j.hrthm.2016.02.007","article-title":"Electrophysiological findings after surgical thoracoscopic atrial fibrillation ablation","volume":"13","author":"Osmancik","year":"2016","journal-title":"Heart Rhythm"},{"key":"2021080208043589800_ezab064-B12","doi-asserted-by":"crossref","first-page":"2024","DOI":"10.1016\/j.athoracsur.2017.05.018","article-title":"Delayed electroanatomic mapping after surgical ablation for persistent atrial fibrillation","volume":"104","author":"Bulava","year":"2017","journal-title":"Ann Thorac Surg"},{"key":"2021080208043589800_ezab064-B13","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1007\/s12471-019-1228-3","article-title":"Hybrid atrial fibrillation ablation in patients with persistent atrial fibrillation or failed catheter ablation","volume":"27","author":"Al-Jazairi","year":"2019","journal-title":"Neth Heart J"},{"key":"2021080208043589800_ezab064-B14","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1161\/CIRCULATIONAHA.112.098079","article-title":"A comprehensive evaluation of rhythm monitoring strategies for the detection of atrial fibrillation recurrence: insights from 647 continuously monitored patients and implications for monitoring after therapeutic interventions","volume":"126","author":"Charitos","year":"2012","journal-title":"Circulation"},{"key":"2021080208043589800_ezab064-B15","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1093\/eurheartj\/ehaa612","article-title":"2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS)","volume":"42","author":"Hindricks","year":"2020","journal-title":"Eur Heart J"},{"key":"2021080208043589800_ezab064-B16","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1111\/jce.13825","article-title":"Arrhythmogenecity and thrombogenicity of the residual left atrial appendage stump following surgical exclusion of the appendage in patients with atrial fibrillation","volume":"30","author":"Mohanty","year":"2019","journal-title":"J Cardiovasc Electrophysiol"},{"key":"2021080208043589800_ezab064-B17","doi-asserted-by":"crossref","first-page":"1180","DOI":"10.1016\/j.amjcard.2018.12.047","article-title":"Comparison of accuracy of left atrial area and volume by two-dimensional trans-thoracic echocardiography versus computed tomography","volume":"123","author":"Arsanjani","year":"2019","journal-title":"Am J Cardiol"},{"key":"2021080208043589800_ezab064-B18","doi-asserted-by":"crossref","first-page":"845","DOI":"10.1093\/ejechocard\/jeq074","article-title":"Left atrial function assessed by trans-thoracic echocardiography in patients treated by ablation for a lone paroxysmal atrial fibrillation","volume":"11","author":"Donal","year":"2010","journal-title":"Eur J Echocardiogr"}],"container-title":["European Journal of Cardio-Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ejcts\/article-pdf\/60\/2\/222\/39502567\/ezab064.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ejcts\/article-pdf\/60\/2\/222\/39502567\/ezab064.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,8,2]],"date-time":"2021-08-02T08:13:56Z","timestamp":1627892036000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejcts\/article\/60\/2\/222\/6184825"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,24]]},"references-count":18,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2021,3,24]]},"published-print":{"date-parts":[[2021,7,30]]}},"URL":"https:\/\/doi.org\/10.1093\/ejcts\/ezab064","relation":{},"ISSN":["1010-7940","1873-734X"],"issn-type":[{"type":"print","value":"1010-7940"},{"type":"electronic","value":"1873-734X"}],"subject":[],"published-other":{"date-parts":[[2021,8,1]]},"published":{"date-parts":[[2021,3,24]]}}}