Real-world outcomes of contemporary hybrid ablation procedures in patients with AF from the TRAC-AF registry

Abstract 2302536, presented at Western Atrial Fibrillation Symposium 2026

To evaluate real-world outcomes of hybrid epicardial-endocardial ablation from a multi-center, observational patient registryThe Tracking Results of Ablations to Combat Atrial Fibrillation Registry Generation 2 (TRAC-AF, NCT05111015) captures real-world safety and effectiveness data on cardiac ablation procedures. IRB approval was obtained for participating institutions. Patient consent was provided. All patients who had a hybrid ablation procedure that included left atrial posterior wall isolation using a unipolar radiofrequency device (EPi-Sense/ST, AtriCure, Inc.) were included; additional lesions were permitted. Effectiveness endpoints were freedom from AF/atrial flutter (AFL)/atrial tachycardia (AT) >30 seconds or as predominant rhythm status after a 3-month blanking period, evaluated using the Kaplan-Meier method. Safety was epicardial ablation procedure-related adverse events through 30-days. Analysis was performed with SAS 9.4 by NAMSA (Toledo, OH).Among 101 patients (21% female) from 6 centers, mean age was 66.3 ± 8.6 years, BMI was 34.0 ± 6.7, CHA2DS2-VASc was 2.5 ± 1.6, and HAS-BLED was 1.7 ± 1.0. Baseline AF type was 9.9% (10/101) paroxysmal, 54.5% (55/101) persistent, and 35.6% (36/101) longstanding persistent. Thirty-three (32.7%) patients had one or more failed catheter ablations. Epicardial approach was subxiphoid in 87.1% (88/101), transdiaphragmatic in 1.0% (1/101), bilateral thoracoscopic in 2.0% (2/101), left unilateral thoracoscopic in 11.9% (12/101), and other in 3.0% (3/101) of patients. Robotics were used in 10.9% (11/101). Ninety-six percent (97/101) of patients had concomitant LAA exclusion, with ligament of Marshall interrupted in 67.3% (68/101). Within 30 days, there were no serious adverse events (SAEs) adjudicated as related to the epicardial ablation procedure or device. Four patients (4%) had a total of 6 non-SAEs related to the epicardial ablation procedure. Among 48 patients with rhythm/reintervention data after a 90-day blanking period, freedom from AF/AFL/AT was 85.3%, and freedom from AF was 90.1% through 12-months.Contemporary real-world practice of hybrid ablation with concomitant LAA exclusion was safe and effective in patients with primarily non-paroxysmal AF, a third of whom had failed prior catheter ablation. These results are consistent with the CONVERGE trial and published literature.