Atrial Fibrillation Catheter Ablation Versus Surgical Ablation Treatment (FAST): A 2-Center Randomized Clinical Trial
Abstract
BACKGROUND: Catheter ablation (CA) and minimally invasive surgical ablation (SA) have become accepted therapy for antiarrhythmic drug-refractory atrial fibrillation. This study describes the first randomized clinical trial comparing their efficacy and safety during a 12-month follow-up. METHODS AND RESULTS: One hundred twenty-four patients with antiarrhythmic drug-refractory atrial fibrillation with left atrial dilatation and hypertension (42 patients, 33%) or failed prior CA (82 patients, 67%) were randomized to CA (63 patients) or SA (61 patients). CA consisted of linear antral pulmonary vein isolation and optional additional lines. SA consisted of bipolar radiofrequency isolation of the bilateral pulmonary vein, ganglionated plexi ablation, and left atrial appendage excision with optional additional lines. Follow-up at 6 and 12 months was performed by ECG and 7-day Holter recording. The primary end point, freedom from left atrial arrhythmia >30 seconds without antiarrhythmic drugs after 12 months, was 36.5% for CA and 65.6% for SA (P=0.0022). There was no difference in effect for subgroups, which was consistent at both sites. The primary safety end point of significant adverse events during the 12-month follow-up was significantly higher for SA than for CA (n=21 [34.4%] versus n=10 [15.9%]; P=0.027), driven mainly by procedural complications such as pneumothorax, major bleeding, and the need for pacemaker. In the CA group, 1 patient died at 1 month of subarachnoid hemorrhage. CONCLUSION: In atrial fibrillation patients with dilated left atrium and hypertension or failed prior atrial fibrillation CA, SA is superior to CA in achieving freedom from left atrial arrhythmias after 12 months of follow-up, although the procedural adverse event rate is significantly higher for SA than for CA. CLINICAL TRIAL REGISTRATION: URL: http://clinicaltrials.gov. Unique identifier: NCT00662701.
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Thoracoscopic pulmonary vein isolation with bipolar radiofrequency prevents recurrence of paroxysmal atrial fibrillation (69-91% freedom from arrhythmias at 1 year).
“Thoracoscopic PVI with bipolar radiofrequency prevents recurrence of paroxysmal AF (69-91% freedom from arrhythmias at 1 year, see Figure 18B for lesion set), 468,809,810”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [468]
The average length of hospital stay for thoracoscopic ablation varies from 3.6 to 6.0 days.
“The average length of hospital stay for thoracoscopic ablation varies from 3.6 to 6.0 days.468,812,813”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [468]
The FAST trial and another smaller trial suggested that thoracoscopic atrial fibrillation surgery could be more effective than catheter ablation for the maintenance of sinus rhythm.
“The FAST (Atrial Fibrillation Catheter Ablation vs Surgical Ablation Treatment) trial, 468 and another smaller trial, 814 suggested that thoracoscopic AF surgery could be more effective than catheter ablation for the maintenance of sinus rhythm, 468,814”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [468]
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- Authors
- Boersma, L. V. A., Castella, M., van Boven, W., Berruezo, A., Yilmaz, A., Nadal, M., Sandoval, E., Calvo, N., Brugada, J., Kelder, J., Wijffels, M., & Mont, L.
- Affiliations
- St. Antonius Ziekenhuis (NL)
- From the Departments of Cardiology (L.V.A.B., J.K., M.W.) and Cardiothoracic Surgery (W.J.v.B., A.Y.), St. Antonius Hospital, Nieuwegein, the Netherlands, and Thorax Institute, Hospital Clinic, University of Barcelona, Barcelona, Catalonia, Spain (M.C., A.B., M.N., E.S., N.C., J.B., L.M.).
- ORCID
- Venue
- Circulation
- Published
- 2012-01
- Volume
- 125
- Issue
- 1
- Pages
- 23-30
- ISSN
- 0009-7322 (ISSN-L)
- 1524-4539
- OpenAlex
- W1995144263
- Cited by
- 396
- References
- 30
- Citations by year
- 2026: 9 · 2025: 11 · 2024: 25 · 2023: 13 · 2022: 12 · 2021: 25 · 2020: 28 · 2019: 24 · 2018: 26 · 2017: 48 · 2016: 30 · 2015: 38 · 2014: 34 · 2013: 40 · 2012: 31
- FWCI
- 23.48
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation (publishedVersion)
- PubMed (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- atrial fibrillation, catheter ablation, pulmonary vein isolation, ganglionated plexus ablation, left atrial appendage excision, drug-refractory atrial fibrillation, left atrial enlargement, hypertension, procedural complications
- MeSH terms
- Atrial Fibrillation, Female, Follow-Up Studies, Humans, Male, Middle Aged, Prospective Studies, Treatment Outcome, Catheter Ablation, Minimally Invasive Surgical Procedures
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