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.