Hybrid Ablation vs. Catheter Ablation for Persistent Atrial Fibrillation: What the HARTCAP-AF Trial Found

Table of Contents

• Key Points
• Understanding Atrial Fibrillation and the Treatment Challenge
• Why This Study Was Needed
• Study Design and Who Participated
• How the Two Procedures Were Performed
• Key Findings: Does Hybrid Ablation Work Better?
• Safety Results: Were There More Complications?
• Procedure Time, Hospital Stay, and Radiation Exposure
• Study Limitations: What This Trial Could Not Prove
• What This Means for Patients
• Recommendations for Patients Considering AF Treatment
• Frequently Asked Questions
• Source Information

Key Points

• In a 41-patient randomized trial, hybrid ablation freed 89% from atrial arrhythmias at 12 months, versus 41% for catheter ablation.
• Hybrid ablation combines thoracoscopic epicardial ablation with transvenous endocardial validation and left atrial appendage closure.
• No deaths, strokes, or cardiac tamponade occurred in either group; major complications were rare and comparable.
• Hybrid ablation took about 1.5 hours longer and required 4-day hospitalization, but radiation exposure was significantly lower.
• 95% of hybrid patients stopped anti-arrhythmic drugs by one year, versus 36% in the catheter ablation group.

Understanding Atrial Fibrillation and the Treatment Challenge

Atrial fibrillation (AF) is the most common heart rhythm disorder, affecting millions of people worldwide. In AF, the upper chambers of the heart (the atria) beat chaotically instead of pumping blood effectively. This can lead to symptoms such as palpitations, shortness of breath, fatigue, and an increased risk of stroke.

There are two main types of AF relevant to this study: persistent AF, where the abnormal rhythm lasts longer than 7 days and requires treatment to restore normal rhythm, and long-standing persistent AF, where the rhythm has been abnormal for more than 12 months. Both types are more difficult to treat than paroxysmal AF (episodes that come and go on their own).

Catheter ablation (CA) is a minimally invasive procedure where thin, flexible tubes called catheters are threaded through blood vessels — usually from the groin — up to the heart. A doctor then uses radiofrequency energy (heat) to create small scars on the heart tissue that block the abnormal electrical signals causing AF. This technique works very well for paroxysmal AF, with success rates above 80%.

However, for persistent AF, the results are much less satisfactory, "rather disappointing, independent of the ablation strategy applied," as the study authors noted. The reasons are that persistent AF often involves more complex changes in the heart's electrical system, including areas beyond the pulmonary veins (the blood vessels that bring oxygen-rich blood from the lungs to the heart's left atrium).

Why This Study Was Needed

Because standard catheter ablation alone often fails to cure persistent AF, doctors have developed a more comprehensive approach called hybrid ablation (HA). This combines two methods in a single procedure:

• Thoracoscopic epicardial ablation: A surgeon makes small incisions (ports) in the chest and uses a tiny camera (thoracoscope) to reach the outside of the heart. Using a clamping device, the surgeon creates ablation lesions on the outer surface of the heart (epicardium).
• Transvenous endocardial ablation: An electrophysiologist threads catheters through the veins to the inside of the heart (endocardium) to verify that the ablation lines created surgically are complete and to fill any gaps ("touch-up" ablation).

Previous research and a meta-analysis suggested that hybrid ablation might be more effective than catheter ablation at restoring normal rhythm in persistent AF patients, though with a slightly higher complication rate. However, no direct, head-to-head randomized controlled trial had ever compared the two strategies. The authors of this study set out to answer this question definitively.

They hypothesized that a single-stage hybrid ablation would lead to a higher rate of freedom from atrial tachyarrhythmias at 12 months compared with catheter ablation — even when allowing repeat catheter ablations in the catheter-only group within the first 6 months — without increasing the number of major and minor complications.

Study Design and Who Participated

The study, called HARTCAP-AF (Hybrid Versus Catheter Ablation in Persistent AF), was a prospective, open-label (unblinded), superiority randomized controlled trial conducted at Maastricht University Medical Centre in the Netherlands. Patient enrollment ran from October 2016 through December 2018.

The study was designed to answer a simple question: in patients with persistent AF, is hybrid ablation superior to catheter ablation? The researchers carefully calculated how many participants they would need. They estimated the success rate (freedom from any supraventricular arrhythmia lasting more than 5 minutes without anti-arrhythmic drugs) at 12 months would be 83% after a single hybrid ablation and 35% after a single catheter ablation, based on previous publications. With a significance level of alpha=0.05 and 90% power, they determined that 20 patients were needed in each arm.

The flow of patients through the study was as follows:

1. 98 patients were assessed for eligibility
2. 10 patients were excluded based on inclusion/exclusion criteria
3. 43 patients declined to participate
4. 2 patients withdrew informed consent
5. 2 patients were excluded because they were referred for concomitant cardiac surgery
6. Final study population: 41 patients — 19 randomized to hybrid ablation and 22 to catheter ablation

All 41 patients received the treatment they were randomized to and completed 12 months of follow-up.

Inclusion criteria were: age over 18 years, symptomatic (long-standing) persistent AF that had not responded to one or more Vaughan-Williams class I or III anti-arrhythmic drugs (medications that control heart rhythm), and no prior catheter or surgical ablation.

Exclusion criteria included: left atrial diameter larger than 60 mm (a severely enlarged upper heart chamber), contraindications for ablation, prior ablation, body mass index (BMI) greater than 40 kg/m², history of cardiac surgery, life expectancy under 12 months, and pregnancy.

Randomization was performed in a 1:1 ratio using a block design, stratified based on AF type, through the Clinical Trial Centre Maastricht using the ALEA software program. The study was approved by the Institutional Review Board of Maastricht University Medical Centre (METC162011/NCT02441738).

Baseline Characteristics of the Patients

Both groups were well matched in many ways, but there were some notable differences at the start of the study:

• Age: The average age was 64±9 years in the hybrid ablation group and 64±8 years in the catheter ablation group
• Women: Only 5% of the hybrid group were women versus 18% in the catheter group
• AF type: 90% of hybrid patients had persistent AF (not long-standing) versus 91% in the catheter group
• CHA₂DS₂-VASc score >3 (a measure of stroke risk): 53% in the hybrid group versus 27% in the catheter group
• Congestive heart failure: 5% of hybrid patients versus 27% of catheter patients
• COPD (chronic lung disease): 10% of hybrid patients versus 0% of catheter patients
• Obstructive sleep apnea: 26% versus 14%
• Left atrial volume index (a measure of atrial enlargement): 54±16 mL/m² in the hybrid group versus 49±8 mL/m² in the catheter group
• Average AF duration: 22 months (range 6–455 months) in the hybrid group versus 33 months (range 12–221 months) in the catheter group
• Previous electrical cardioversion (a procedure using electric shocks to restore normal rhythm): 95% versus 91%

In short, the hybrid ablation group had more patients with higher stroke risk scores, more COPD and sleep apnea, and more severe left atrial enlargement, while the catheter group had more women and more patients with congestive heart failure. These differences were not all statistically significant, but they are worth keeping in mind when interpreting the results.

How the Two Procedures Were Performed

The Hybrid Ablation Procedure

All hybrid procedures were performed by a dedicated team consisting of an experienced cardiac surgeon and an electrophysiologist working together. The procedure was performed under general anesthesia with double-lumen endotracheal intubation (a breathing tube that allows one lung to be intentionally deflated so the surgical team can reach the heart more easily).

Before ablation began, doctors confirmed there were no blood clots in the heart by performing a transesophageal echocardiogram (an ultrasound probe passed down the throat to get detailed images of the heart).

The surgical part of the procedure used video-assisted thoracoscopic surgery (VATS) with a 3-port access approach, entering the chest in the third, fifth, and seventh intercostal spaces (the spaces between the ribs). The pericardium (the sac around the heart) was opened behind the phrenic nerve (the nerve that controls the diaphragm), and the tissue reflections around both vena cava (the large veins returning blood to the heart) were exposed.

Once the surgeons had access to the transverse and oblique sinuses (natural openings around the major blood vessels of the heart), they performed isolation of the left pulmonary veins using a bipolar radiofrequency (RF) clamp (Synergy System, AtriCure). They then created a "box lesion" — a set of connecting ablation lines that isolate the entire posterior (back) wall of the left atrium. This was done using a unidirectional bipolar RF pen (Coolrail, AtriCure). The right pulmonary veins were then isolated. In 14 patients (74%), a left-sided approach alone was sufficient; only 5 patients (26%) required a bilateral approach. In 5 patients, additional ablation of the ganglionated plexus (nerve clusters on the heart that can trigger AF) was performed.

In all patients, the left atrial appendage (LAA — a small pouch on the left atrium where blood clots often form in AF patients) was closed or excluded using one of two devices:

• AtriClip Pro or AtriClip Pro 2 (AtriCure) in 17 patients — a clip placed at the base of the appendage
• Lariat (SentreHEART) closure device in 2 patients — a lasso-like device that ties off the appendage

After the surgical ablation was complete, the team performed transvenous endocardial validation — threading a catheter through the veins to the inside of the heart to check whether the ablation lines created from the outside were truly complete. A 3.5-mm tip ablation catheter (Thermocool Smarttouch, Biosense Webster) was used to test for "entry block" and "exit block" (meaning no electrical signals can pass through the ablation lines in either direction).

Eight patients (42%) needed endocardial touch-up ablation because of gaps found in the ablation lines. The gaps were located:

• In the roof line of the box lesion in 5 patients
• In the inferior line in 1 patient
• Around the right superior pulmonary vein in 2 patients
• At the left and right carina (where the airways branch into the lungs) in 1 patient

After touch-up, all patients achieved entry and exit block of the pulmonary veins and the box lesion. Additional ablation lines were placed when needed: a cavotricuspid isthmus (CTI) line in 14 patients (to treat or prevent atrial flutter) and a mitral isthmus line in 1 patient.

The Catheter Ablation Procedure

The catheter ablation procedure was performed under sedation. A coronary sinus catheter was first placed under fluoroscopic (X-ray) guidance. Then, an echo-guided double trans-septal puncture was performed — creating two holes in the wall between the upper chambers of the heart to allow catheters to reach the left atrium. The patient received heparin (a blood thinner) adjusted to body weight, with a target activated clotting time above 300 seconds, maintained by continuous heparin infusion.

Doctors created a 3-dimensional electroanatomic map of the left atrium, then performed ablation using an irrigated-tip contact force-sensing catheter (ThermoCool Smarttouch, Biosense Webster). Automated lesion tagging (VisiTag, Biosense Webster) marked each ablation site.

Power settings were:

• Anterior wall: 30–35 W with an ablation index of 500
• Posterior wall: 25–30 W with an ablation index of 400

The minimum lesion set in the catheter arm was bilateral pulmonary vein isolation plus a box lesion excluding the posterior left atrium. If patients had previously documented atrial flutter or atrial tachycardia, additional ablation was performed. Successful additional CTI ablation was performed in 46% of patients (n=10). Endocardial validation confirmed complete pulmonary vein isolation in all patients, and entry/exit block of the box lesion was confirmed in all but 2 patients (91%).

For both procedures, electrical cardioversion (a controlled electric shock) was used to restore normal rhythm if the patient was still in AF or atrial flutter at the end of the ablation.

Key Findings: Does Hybrid Ablation Work Better?

The results clearly favor hybrid ablation, with statistically significant differences on the primary and secondary effectiveness endpoints.

Primary Effectiveness Endpoint

The primary endpoint was freedom from any supraventricular tachyarrhythmia (any abnormally fast rhythm arising from the upper chambers of the heart) lasting longer than 5 minutes, without the use of anti-arrhythmic drugs (AADs), as recorded on a 12-lead ECG and 7-day Holter monitor, after the 3-month "blanking period" (a grace period after ablation during which early arrhythmias are not counted as treatment failures) and continuing until 12 months after the last procedure.

The result: 17 of 19 patients (89%) in the hybrid ablation group were free from atrial tachyarrhythmias versus only 9 of 22 patients (41%) in the catheter ablation group (P=0.002). This means that hybrid ablation more than doubled the likelihood of being arrhythmia-free at one year.

Secondary Effectiveness Endpoints

The results for secondary effectiveness endpoints were equally striking:

• Freedom from any supraventricular tachyarrhythmia lasting >30 seconds off AADs: 89% in the hybrid group versus 36% in the catheter group (P<0.001)
• Freedom from documented atrial tachyarrhythmias allowing AADs: 95% versus 41% (P<0.001)
• Freedom from class I/III anti-arrhythmic drug use: 95% versus 68% (P=0.050)
• Patients off all AADs after 1 year: 95% in the hybrid group versus 36% in the catheter group (P=0.005)
• Number of cardioversions after the blanking period: 1 (5%) in the hybrid group versus 5 (23%) in the catheter group (P=0.350) — a difference that was not statistically significant, but shows a strong trend
• Redo catheter ablations after 6 months: 1 (5%) versus 5 (23%) (P=0.191)
• Arrhythmia-related hospital admissions: 1 (5%) in each group (P=1.000)
• Freedom from AAD I/III: 18 (95%) versus 15 (68%), P=0.050

It is important to note that although repeat catheter ablations within the first 6 months after the initial procedure were not counted as failures in the catheter group (as allowed by the study protocol), no patients in the catheter arm actually underwent a redo ablation within that 6-month window.

What Happened to Patients Who Experienced Recurrences?

In the hybrid ablation group, only 1 patient had a recurrence — an atrial tachycardia (AT) and atrial flutter (AFL). During the repeat procedure, the team found that the box lesion, pulmonary veins, and CTI line were all still isolated. A micro-reentry AT at the anterior wall of the left atrium was successfully ablated with radiofrequency energy from the right superior pulmonary vein to the mitral valve annulus, with bidirectional block achieved, and the patient converted back to normal rhythm.

In the catheter ablation group, 13 patients experienced a recurrence:

• Paroxysmal AF: 8 patients
• Atrial flutter plus atrial tachycardia: 1 patient
• Atrial tachycardia alone: 1 patient
• Atrial flutter alone: 1 patient
• Persistent AF: 1 patient
• Persistent AF plus atrial flutter: 1 patient

Of those 13 patients, 5 underwent a repeat catheter ablation and 4 underwent electrical cardioversion (with or without adding anti-arrhythmic drugs). All converted to normal sinus rhythm afterward.

Safety Results: Were There More Complications?

The good news is that both procedures were safe, with no deaths, no strokes, no cardiac tamponade, no pacemaker implantations, and no conversions to sternotomy (opening the chest fully) in either group.

The primary safety endpoint was a composite of major adverse events and complications occurring within 12 months of follow-up. These included: death, stroke, bleeding requiring transfusion and/or reoperation, cardiac tamponade or pericardial effusion requiring intervention, empyema (pus in the chest cavity), myocardial infarction (heart attack), pericarditis requiring pericardiocentesis (draining fluid from the sac around the heart) or prolonged hospitalization, pneumothorax requiring intervention (collapsed lung requiring treatment), gastroparesis (delayed stomach emptying), symptomatic pulmonary vein stenosis greater than 70%, or persistent diaphragmatic paresis (weakness of the diaphragm).

Major complications were rare in both groups:

• Hybrid ablation group: 1 patient developed pericarditis requiring pericardiocentesis
• Catheter ablation group: 1 patient had bleeding from the femoral artery (the large artery in the groin) that required surgical intervention

There were no other major complications — no cardiac tamponade, no conversion to sternotomy, no strokes in either group.

Minor complications were also uncommon:

• Hybrid ablation group: 1 patient developed a femoral arteriovenous fistula (an abnormal connection between an artery and vein in the groin) as a vascular access complication
• Catheter ablation group: 1 patient's ablation procedure had to be postponed because of hematuria (blood in the urine) when inserting a urinary bladder catheter, until a urologist could evaluate the situation

In both patients who received LAA closure using the Lariat device, adequate closure was confirmed on postoperative transthoracic echocardiography (an ultrasound of the heart).

The overall rate of (serious) adverse events was 21% in the hybrid group versus 14% in the catheter group, a difference that was not statistically significant (P=0.685). This tells us that hybrid ablation did not come at the price of significantly more complications.

Procedure Time, Hospital Stay, and Radiation Exposure

The two procedures differed substantially in several practical ways, as summarized in the table below (values are medians with interquartile ranges):

• Radiation dose: 31 cGy·cm² (8–69) in the hybrid group versus 67 cGy·cm² (8–153) in the catheter group — significantly lower radiation exposure with hybrid ablation (P=0.004)
• Total radiation exposure time: 23 minutes (0–1 hour 59 minutes) for hybrid versus 1 hour 54 minutes (1:05–2:34) for catheter — significantly lower with hybrid (P<0.001)
• Total procedure time: 4 hours 16 minutes (3:03–5:55) for hybrid versus 2 hours 53 minutes (2:05–3:34) for catheter — significantly longer with hybrid (P<0.001)
• Length of hospital stay: 4 days (3–7) for hybrid versus 2 days (1–7) for catheter — significantly longer with hybrid (P<0.001)

These differences make sense: the hybrid procedure involves both a surgical and catheter component, hence the longer duration and hospitalization. But the surgical approach reduces the need for fluoroscopy (real-time X-ray imaging), thereby cutting radiation exposure roughly in half.

Study Limitations: What This Trial Could Not Prove

As with any study, this trial has important limitations that patients should understand when interpreting the results:

• Small sample size: With only 41 patients total (19 hybrid, 22 catheter), the study was not large enough to detect differences in rare safety events. The sample size calculation required 20 patients per arm for the efficacy endpoint, but safety events are much rarer and would require a much larger study to compare definitively.
• Unblinded design: Both patients and doctors knew which treatment was given. This is practically unavoidable in procedural trials (you cannot easily "sham" surgery), but it could introduce bias in outcome assessment or patient-reported measures.
• Single center: All procedures were performed at one experienced academic medical center by a dedicated team of specialists. Results may not be generalizable to lower-volume centers or less experienced teams.
• Baseline imbalances: The two groups were not perfectly balanced at randomization. The hybrid group had more patients with COPD, sleep apnea, higher stroke risk scores, and more severe atrial enlargement, while the catheter group had more women and more patients with heart failure. Although these differences were not all statistically significant, they could have influenced outcomes.
• Short follow-up: The results cover only 12 months. Longer-term durability of the hybrid approach beyond 1 year is unknown.
• Specific patient population: Patients with extremely enlarged atria (>60 mm), prior ablation, or prior cardiac surgery were excluded. The results may not apply to those groups.
• Protocol allowed redo ablations only in the CA group: By design, the catheter group could receive repeat catheter ablations within 6 months without being counted as a failure, while re-interventions in the hybrid group after the blanking period counted as failures. This design actually favors the catheter group, yet the hybrid group still performed significantly better — strengthening the study's conclusions. Notably, however, no patient in the catheter arm actually underwent an early redo ablation.

What This Means for Patients

This trial provides the strongest evidence to date that hybrid ablation is superior to catheter ablation for patients with persistent atrial fibrillation. The 48-percentage-point absolute difference in success rates (89% vs. 41%) is substantial and clinically meaningful. It means that for every ~2 patients treated with hybrid ablation instead of catheter ablation, one additional patient will be free of arrhythmia at 12 months.

For patients with persistent AF who have failed medication, the study suggests that a one-stage combined approach — surgery plus catheter validation — can offer a realistic chance of being completely free of arrhythmia and off anti-arrhythmic medications one year later. Importantly, 95% of hybrid patients were off anti-arrhythmic drugs after 1 year, versus only 36% in the catheter group.

The trade-offs are clear: hybrid ablation requires a longer procedure (about 1.5 hours more), a longer hospital stay (4 vs. 2 days), and involves small chest incisions. However, this comes with significantly lower radiation exposure, and — importantly — no increase in major complications in this study. The 21% adverse event rate in the hybrid group was not statistically different from the 14% rate in the catheter group (P=0.685), although the study was not powered to rule out small differences in safety.

Another notable aspect of the hybrid approach is that all patients received left atrial appendage (LAA) closure or exclusion. In addition to potentially reducing stroke risk, this may contribute to the electrical benefits of the procedure, as the LAA can be a source of arrhythmia-triggering signals.

While hybrid ablation is not widely available at every hospital and requires close collaboration between cardiac surgeons and electrophysiologists, this study demonstrates that when performed by a dedicated, experienced team, it is both effective and safe.

Recommendations for Patients Considering AF Treatment

If you or a loved one has persistent atrial fibrillation and is considering ablation, here are some practical takeaways based on this study:

1. Discuss hybrid ablation with your heart team: Ask whether your medical center offers thoracoscopic hybrid ablation and whether you might be a candidate. Not every center has this capability, and it requires a specialized team.
2. Consider your specific anatomy and risk factors: The study excluded patients with very large atria (>60 mm), prior cardiac surgery, prior ablation, and severe obesity (BMI >40). Your suitability depends on your individual circumstances.
3. Weigh the trade-offs: Hybrid ablation means a longer procedure (over 4 hours on average), a hospital stay of about 4 days, and small chest incisions. The upside is a much higher chance of being arrhythmia-free at 12 months (89% vs. 41%) and a very high chance of stopping rhythm-control medications (95%).
4. Ask about radiation exposure: If radiation exposure is a concern (e.g., in younger patients or women of childbearing age), the hybrid approach offers significantly lower radiation dose and exposure time compared to catheter ablation alone.
5. Choose an experienced center: All procedures in this trial were done by a dedicated team of experienced surgeons and electrophysiologists. Success rates and complication rates may vary with operator experience.
6. Expect the full treatment package: In this study, hybrid ablation always included LAA closure (with an AtriClip or Lariat device) plus a posterior wall box lesion, not just pulmonary vein isolation. Ask your team about the exact lesion set they plan to perform.
7. Understand the follow-up plan: The study included ECG and Holter monitoring at 3, 6, and 12 months, including a 7-day Holter at 1 year. Good follow-up is essential to detect silent arrhythmia recurrences.

Ultimately, the decision between hybrid ablation and catheter ablation should be made jointly by you, your cardiologist, and your heart surgeon, taking into account your anatomy, symptoms, risk factors, preferences, and the expertise available at your treatment center. The evidence from this randomized trial is encouraging: a one-time combined approach may offer the best chance yet of restoring normal rhythm in patients with persistent AF.

Frequently Asked Questions

What is hybrid ablation for persistent atrial fibrillation?

Hybrid ablation is a one-stage procedure combining two approaches: a surgeon makes small chest incisions to ablate the heart’s outer surface, then a catheter specialist checks the inside and fills any gaps. In this trial, it always included left atrial appendage closure and a posterior wall box lesion.

Is hybrid ablation safe? What complications can occur?

In this trial, neither procedure caused death, stroke, or cardiac tamponade. Major complications were rare: one hybrid patient developed pericarditis needing drainage, and one catheter patient had groin bleeding requiring surgery. Overall adverse event rates were 21% for hybrid and 14% for catheter — not a statistically significant difference.

What is recovery like after hybrid ablation? How long is hospital stay?

Hybrid ablation takes longer, on average 4 hours 16 minutes, versus 2 hours 53 minutes for catheter ablation. Hospital stay is also longer: about 4 days versus 2 days. The hybrid approach uses small chest incisions, and radiation exposure is significantly lower than with catheter ablation.

Am I a candidate for hybrid ablation?

This study included adults with symptomatic persistent AF who had failed at least one rhythm-control medication and had no prior ablation or cardiac surgery. People with very enlarged atria (over 60 mm), BMI above 40, prior ablation, or prior heart surgery were excluded. Talk to your heart team about your specific suitability.

Will I still need to take anti-arrhythmic drugs after hybrid ablation?

One year after the procedure, 95% of hybrid ablation patients were free from anti-arrhythmic drugs, compared to only 36% in the catheter ablation group. This difference was significant. If avoiding long-term rhythm medications is important to you, hybrid ablation may offer that advantage.

Why does hybrid ablation work better than catheter ablation alone?

Hybrid ablation treats both the outside and inside of the heart, ensures complete ablation lines with verification, and routinely closes the left atrial appendage — a common source of stroke and arrhythmia-triggering signals. The combined surgical and catheter approach targets more complex areas beyond the pulmonary veins, which is important in persistent AF.

For persistent atrial fibrillation that has not responded to medication, should I get a second opinion before deciding between hybrid ablation and another catheter ablation?

Yes. This randomized trial compared the two options head-to-head. At 12 months, 89% of patients who had hybrid ablation were free from atrial arrhythmias, versus 41% with catheter ablation, without a significant difference in major complications. But hybrid ablation takes longer, usually means about a 4-day hospital stay, and requires a specialized surgeon-electrophysiologist team, so the choice depends heavily on your center's expertise and your own anatomy and risk factors. A second opinion can confirm whether that combined approach is realistically available and appropriate for you. Diagnostic Detectives Network provides independent expert second opinions.

Source Information

Original article title: Hybrid Ablation Versus Repeated Catheter Ablation in Persistent Atrial Fibrillation: A Randomized Controlled Trial (HARTCAP-AF)

Authors: Claudia A.J. van der Heijden, MD; Vanessa Weberndörfer, MD; Mindy Vroomen, MD, PhD; Justin G. Luermans, MD, PhD; Sevasti-Maria Chaldoupi, MD, PhD; Elham Bidar, MD, PhD; Kevin Vernooy, MD, PhD; Jos G. Maessen, MD, PhD; Laurent Pison, MD, PhD; Sander M.J. van Kuijk; Mark La Meir, MD, PhD; Harry J.G.M. Crijns, MD, PhD; Bart Maesen, MD, PhD

Journal: JACC: Clinical Electrophysiology, Volume 9, No. 7, July 2023, pages 1013–1023

Trial registration: NCT02441738 (ClinicalTrials.gov)

Funding/Disclosures: The study was conducted at Maastricht University Medical Centre, the Netherlands, with support from the Cardiovascular Research Institute Maastricht. The authors declared compliance with human studies committees and institutional review board approval (METC162011).

Note: This patient-friendly article is based on peer-reviewed research originally published by Elsevier on behalf of the American College of Cardiology Foundation under a CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). This summary is for educational purposes and does not constitute medical advice. Always consult your healthcare provider about your specific condition and treatment options.