Address for correspondence:
Paolo Compagnucci, MD
Cardiology and Arrhythmology Clinic and Department of Biomedical Sciences and Public Health
University Hospital “Ospedali Riuniti” and Marche Polytechnic University
Via Tronto 10/a
60126, Ancona, Italy
E-mail:paolocompagnucci1@gmail.com
Data availability statement: data available on request from the authors
Financial support: none
Disclosures: none relevant to this article
Key words: atrial fibrillation; endpoint; follow-up; catheter ablation
We agree with Dr. Norman C. Wang that consistent reporting of one-year outcomes is important to enable comparisons among different techniques in the still evolving field of catheter ablation for persistent atrial fibrillation (AF). In our work, we provided the first description of a novel stepwise approach for longstanding persistent AF, the Mediterranea technique, which critically differs from previously proposed procedures in that it incorporates epicardial ablation of epicardial arrhythmogenic structures (namely, the Bachmann’s bundle and the ligament of Marshall).1
In our first report, we were only able to enroll a limited number of patients (n=25) and to follow them for approximately nine months, therefore our work may well be considered a pilot study.1 At the prespecified one-year follow-up appointment, we did not observe any further recurrences, so that freedom from arrhythmia recurrences measured 88% (22 out of 25) after approximately 12 months. Therefore, our results seem very promising when compared to other hybrid techniques mainly involving posterior wall isolation.2
Obviously, outcomes of such an innovative technique need to be validated in a larger cohort of patients, and we are currently planning to publish such information soon. If confirmed, these results may represent a major leap forward in the treatment of longstanding persistent AF, a condition in which outcomes of endocardial catheter ablation are still disappointing.