Minimally invasive thoracoscopic surgical ablation and hybrid ablation in AF patients: results from a single-arm systematic review and meta-analysis.
| Title: | Minimally invasive thoracoscopic surgical ablation and hybrid ablation in AF patients: results from a single-arm systematic review and meta-analysis. |
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| Authors: | Hanna F; Faculty of Medicine, Cairo University, Giza, Egypt.; Dway A; Al-Andalus University for Medical Sciences, Tartus, Syria. dwayali10@gmail.com.; Abdul-Hafez HA; Department of Medicine, Faculty of Medicine and Health Sciences, An- Najah National University, Nablus, Palestine.; Husseiny YM; Faculty of Medicine, New Giza, Cairo, Egypt.; Hassan AY; Faculty of Medicine, Tanta University, Tanta, Egypt.; Yassin MNA; Faculty of Medicine, Cairo University, Giza, Egypt.; Ayoub BSH; Faculty of Medicine, Cairo University, Giza, Egypt.; Ayesh HJ; Faculty of Medicine, Al-Quds University, Jerusalem, Palestine.; Kandil O; Department of Cardiothoracic Surgery, Mayo Clinic, Arizona, Phoenix, USA.; Elgendy A; Faculty of Medicine, Mansoura University, Mansoura, Egypt.; Hamam NG; Faculty of Medicine, Cairo University, Giza, Egypt.; El-Helbawy A; Faculty of Medicine, Helwan University, Cairo, Egypt. |
| Source: | Journal of cardiothoracic surgery [J Cardiothorac Surg] 2026 May 07. Date of Electronic Publication: 2026 May 07. |
| Publication Model: | Ahead of Print |
| Publication Type: | Journal Article; Review |
| Language: | English |
| Journal Info: | Publisher: BioMed Central Country of Publication: England NLM ID: 101265113 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1749-8090 (Electronic) Linking ISSN: 17498090 NLM ISO Abbreviation: J Cardiothorac Surg Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: [London] : BioMed Central, 2006- |
| Abstract: | Background: Atrial fibrillation (AF) is the most frequent cardiac arrhythmia in adults, with presentations from asymptomatic to severe cardiovascular morbidities. Cardiac ablation treats patients resistant to antiarrhythmic drugs (AAD) using approaches such as bilateral surgical ablation, which permits targeting of superior vena cava lesions but entails longer procedures and higher complication risk, and hybrid ablation that combines epicardial and endocardial techniques.; Method: We performed a meta-analysis per PRISMA guidelines, including observational and interventional single-arm studies of patients undergoing bilateral surgical or hybrid ablation in single- and double-setting subgroups. Studies were selected by predefined criteria, and data were extracted independently by 12 investigators. Searches covered multiple databases up to March 29, 2025.; Result: Thirty-two studies with 1,871 patients were evaluated. Overall complication rates were 0.11 (95% CI: 0.08-0.14) for surgical ablation and 0.13 (95% CI: 0.095-0.17) for hybrid ablation, with no significant subgroup difference (p = 0.093). Arrhythmia-free rates were 0.81 (95% CI: 0.69-0.89) for surgical and 0.76 (95% CI: 0.70-0.85) for hybrid ablation (p = 0.305). Mean operative times were 160.9 min (95% CI: 135 - 186.9) for surgical and 192.65 min (95% CI: 109.3-275.9) for hybrid ablation (p = 0.069). Bleeding rates were 0.03 (95% CI: 0.02-0.04) and 0.049 (95% CI: 0.03-0.07), respectively (p = 0.06). Mortality, stroke, conversion to sternotomy, and hospital length of stay showed no significant differences.; Conclusion: Surgical ablation yielded a slightly higher arrhythmia-free rate and fewer total complications, while hybrid ablation had shorter operative time; subgroup (single vs. double setting) differences were not significant.; (© 2026. The Author(s).) |
| Competing Interests: | Declarations. Ethics approval and consent to participate: This study was conducted following the ethical standards of the institutional research committee and registered with PROSPERO under registration number (CRD420251107935). Competing interests: Fouad Hanna, Ali Dawy, Hamza A. Abdul-Hafez, Yousef M. Husseiny, Ahmed Youssef, Mazen Negmeldin, Basel Saber, Hadeel Jameel Ayesh, Omneya Kandil, Abdelrahman Elgendy, Nada Gamal, and Abdelrahman El-Helbawy have no conflicts of interest or financial ties to disclose. |
| Contributed Indexing: | Keywords: Atrial fibrillation; Bilateral thoracoscopic ablation; Hybrid ablation |
| Entry Date(s): | Date Created: 20260507 Latest Revision: 20260507 |
| Update Code: | 20260508 |
| DOI: | 10.1186/s13019-026-04135-4 |
| PMID: | 42098789 |
| Database: | MEDLINE |
Journal Article; Review