J Appl Biomed 21:67-72, 2023 | DOI: 10.32725/jab.2023.007

Sequential hybrid ablation versus surgical CryoMaze alone for treatment of atrial fibrillation (SurHyb Trial): a protocol of the multicentre randomized controlled trial

Alan Bulava1, *, Aleš Mokráček1, Dan Wichterle2, Petr Budera2, Pavel Osmančík3, Petr Kačer3, Linda Vetešková4, Petr Němec4, Tomáš Skála5, Petr Šantavý5, Jan Chovančík6, Piotr Branny6, Vitalii Rizov7, Miroslav Kolesár7, Marian Rybář8
1 University of South Bohemia in České Budějovice, Faculty of Health and Social Sciences; Cardiac Centre, České Budějovice Hospital, České Budějovice, Czech Republic
2 Institute for Clinical and Experimental Medicine, Praha, Czech Republic
3 Charles University and University Hospital Královské Vinohrady, 3rd Faculty of Medicine, Praha, Czech Republic
4 Centre of Cardiovascular Surgery and Transplantation, Brno, Czech Republic
5 Palacký University, Faculty of Medicine and Dentistry; University Hospital Olomouc, Olomouc, Czech Republic
6 Hospital Agel Třinec-Podlesí, Třinec, Czech Republic
7 Masaryk Hospital, Ústí nad Labem, Czech Republic
8 Czech Technical University in Prague, Faculty of Biomedical Engineering, Department of Biomedical Technology, Kladno, Czech Republic

Background: Atrial fibrillation is common in patients with structural heart disease who are undergoing cardiac surgery. Surgical CryoMaze has been shown to be an effective treatment in several trials, but success rates have varied considerably, between 47-95%. The sequential hybrid approach, combining surgical CryoMaze followed by radiofrequency catheter ablation, can achieve high freedom from atrial arrhythmias. However, in patients with concomitant surgical atrial fibrillation treatment, data comparing the hybrid approach to CryoMaze alone are lacking.

Methods: The SurHyb study was designed as a prospective, open-label, multicentre randomized trial. Patients with non-paroxysmal atrial fibrillation who were scheduled for coronary artery bypass grafting or valve repair/replacement were randomized to either surgical CryoMaze alone or surgical CryoMaze followed by radiofrequency catheter ablation 3 months post-surgery. The primary outcome measure was arrhythmia-free survival without class I or III antiarrhythmic drugs, which has been evaluated using implantable cardiac monitors.

Conclusions: This is the first randomized study that compares concomitant surgical CryoMaze alone with the staged hybrid surgical CryoMaze followed by catheter ablation, in patients with non-paroxysmal atrial fibrillation using rigorous rhythm monitoring. The results may contribute to the optimization of the treatment in patients undergoing concomitant CryoMaze for atrial fibrillation.

Keywords: Atrial fibrillation; Catheter ablation; Cryomaze; Hybrid treatment
Grants and funding:

The study was supported by the Ministry of Health of the Czech Republic, grant nr. NV19-02-00046.

Conflicts of interest:

The authors have no conflict of interests to declare.

Received: February 6, 2023; Revised: April 1, 2023; Accepted: May 5, 2023; Prepublished online: May 11, 2023; Published: June 27, 2023  Show citation

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Bulava A, Mokráček A, Wichterle D, Budera P, Osmančík P, Kačer P, et al.. Sequential hybrid ablation versus surgical CryoMaze alone for treatment of atrial fibrillation (SurHyb Trial): a protocol of the multicentre randomized controlled trial. J Appl Biomed. 2023;21(2):67-72. doi: 10.32725/jab.2023.007. PubMed PMID: 37212155.
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