1
|
On YK, Jeong DS. Updates in hybrid AF ablation: a hybrid approach to surgical epicardial ablation and cather endocardial ablation in persistent atrial fibrillation. INTERNATIONAL JOURNAL OF ARRHYTHMIA 2022. [DOI: 10.1186/s42444-021-00056-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
AbstractAtrial fibrillation (AF) is the most common and increasing cardiac arrhythmia. AF increases thromboembolic events and hospitalizations and deteriorates quality of life. The mechanism of AF is not completely understood. James Cox proposed a concept of Maze procedure in 1987 which was based on a surgical ablation lesion for electrical conduction pathway. Although surgical ablation offers a higher success rate, it should be performed with minimally invasive techniques because of its high invasiveness. Haissaguerre et al. identified potential sources of AF in the pulmonary veins as triggers and developed the percutaneous catheter ablation as the treatment strategy for paroxysmal AF refractory to pharmaceutical therapy. The atrial remodeling occurs electrically and structurally in persistent or longstanding persistent AF, and the catheter ablation and surgical ablation have variable success rates. Persistent or longstanding persistent AF presents a major challenge. Despite continuous improvements, catheter-based procedures have shown relatively far from satisfactory outcomes and may need to be repeated to achieve sinus rhythm. A hybrid approach consisting of the sequential combination of a surgical minimally invasive epicardial ablation and a transvenous catheter endocardial ablation would be an alternative option that supplements the limitations of endo- and epicardial strategies. Close cooperation between cardiac surgeons and electrophysiologists for optimal selection of patients and management for arrhythmia recurrence seems suggestible for persistent or longstanding persistent AF.
Collapse
|
2
|
Maesen B, Bidar E, Luermans JG, Maessen JG. Ablation of persistent atrial fibrillation: the added value of hybrid. Eur J Cardiothorac Surg 2021; 60:231-232. [PMID: 33842938 PMCID: PMC8327200 DOI: 10.1093/ejcts/ezab170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Bart Maesen
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands.,Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Elham Bidar
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands.,Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Justin Glm Luermans
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands.,Department of Cardiology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands.,Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| |
Collapse
|
3
|
Nasso G, Lorusso R, Motekallemi A, Dell'Aquila AM, Di Bari N, Condello I, Moscarelli M, Iacopino S, Serraino GF, Mastroroberto P, Santarpino G, Speziale G. The fate of patients after failed epicardial ablation of atrial fibrillation. J Cardiothorac Surg 2021; 16:249. [PMID: 34488818 PMCID: PMC8422735 DOI: 10.1186/s13019-021-01635-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 08/29/2021] [Indexed: 12/03/2022] Open
Abstract
Background Much debate is still going on about the best ablation strategy—via endocardial or epicardial approach—in patients with atrial fibrillation (AF), and evidence gaps exist in current guidelines in this area. More specifically, there are no clear long-term outcome data after failed surgical AF ablation. Methods Since June 2008, 549 surgical AF ablation procedures through a right minithoracotomy were performed at our institution. From 2008 to 2011, a unipolar radiofrequency device was used (151 patients), whereas from 2011 to 2020 a bipolar radiofrequency device was used (398 patients). Patients were scheduled for surgery on the basis of the following criteria: recurrent episodes of paroxysmal or persistent lone AF refractory to maximally tolerated antiarrhythmic drug dosing and at least one failed cardioversion attempt. Besides the recommended follow-up by the local cardiologist, starting from 2021, surviving patients were asked to undergo assessment of left ventricular function and to complete a questionnaire addressing quality of life and predisposing factors for recurrent AF. Results At a mean follow-up of 77 months, the rate of AF recurrence was 20.7% (n = 114). On multivariate analysis, impaired left ventricular ejection fraction (58 patients, 51%, p = 0.002), worsening of European Heart Rhythm Association (EHRA) symptom class (37 patients, 32%, p = 0.003) and cognitive decline or depression (23 patients, 20%, p = 0.023) during follow-up were found to be significantly associated with AF recurrence. Conclusions Surgical AF ablation through a right minithoracotomy is safe, but a better outcome could be achieved using a hybrid approach. Patients after initial failed surgical AF ablation show worsening of cardiac function, clinical status and quality of life at follow-up compared to patients with successful AF ablation.
Collapse
Affiliation(s)
- Giuseppe Nasso
- Department of Cardiac Surgery, Anthea Hospital, GVM Care and Research, Via Camillo Rosalba, 35/38, Bari, Italy.
| | - Roberto Lorusso
- Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre (MUMC), Maastricht, Netherlands.,Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands
| | - Arash Motekallemi
- Department of Cardiac Surgery, Münster Universität, Münster, Germany
| | | | - Nicola Di Bari
- Department of Cardiac Surgery, "Aldo Moro" University, Bari, Italy
| | - Ignazio Condello
- Department of Cardiac Surgery, Anthea Hospital, GVM Care and Research, Via Camillo Rosalba, 35/38, Bari, Italy
| | - Marco Moscarelli
- Department of Cardiac Surgery, Anthea Hospital, GVM Care and Research, Via Camillo Rosalba, 35/38, Bari, Italy
| | - Saverio Iacopino
- Department of Electrophysiology, Maria Cecilia Hospital, GVM Care and Research, Cotignola, RA, Italy
| | - Giuseppe F Serraino
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - Pasquale Mastroroberto
- Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy
| | - Giuseppe Santarpino
- Department of Cardiac Surgery, Anthea Hospital, GVM Care and Research, Via Camillo Rosalba, 35/38, Bari, Italy.,Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro, Italy.,Department of Cardiac Surgery, Paracelsus Medical University, Nuremberg, Germany
| | - Giuseppe Speziale
- Department of Cardiac Surgery, Anthea Hospital, GVM Care and Research, Via Camillo Rosalba, 35/38, Bari, Italy
| |
Collapse
|