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Wyler von Ballmoos MC, Hui DS, Mehaffey JH, Malaisrie SC, Vardas PN, Gillinov AM, Sundt TM, Badhwar V. The Society of Thoracic Surgeons 2023 Clinical Practice Guidelines for the Surgical Treatment of Atrial Fibrillation. Ann Thorac Surg 2024; 118:291-310. [PMID: 38286206 DOI: 10.1016/j.athoracsur.2024.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/08/2024] [Accepted: 01/13/2024] [Indexed: 01/31/2024]
Abstract
The Society of Thoracic Surgeons 2023 Clinical Practice Guidelines for the Surgical Treatment of Atrial Fibrillation incorporate the most recent evidence for surgical ablation and left atrial appendage occlusion in different clinical scenarios. Substantial new evidence regarding the risks and benefits of surgical left atrial appendage occlusion and the long-term benefits of surgical ablation has been produced in the last 5 years. Compared with the 2017 clinical practice guideline, the current update has an emphasis on surgical ablation in first-time, nonemergent cardiac surgery and its long-term benefits, an extension of the recommendation to perform surgical ablation in all patients with atrial fibrillation undergoing first-time, nonemergent cardiac surgery, and a new class I recommendation for left atrial appendage occlusion in all patients with atrial fibrillation undergoing first-time, nonemergent cardiac surgery. Further guidance is provided for patients with structural heart disease and atrial fibrillation being considered for transcatheter valve repair or replacement, as well as patients in need of isolated left atrial appendage management who are not candidates for surgical ablation. The importance of a multidisciplinary team assessment, treatment planning, and long-term follow-up are reiterated in this clinical practice guideline with a class I recommendation, along with the other recommendations from the 2017 guidelines that remained unchanged in their class of recommendation and level of evidence.
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Affiliation(s)
| | - Dawn S Hui
- Department of Cardiothoracic Surgery, University of Texas Health Science Center at San Antonio, San Antonio, Texas
| | - J Hunter Mehaffey
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
| | - S Chris Malaisrie
- Division of Cardiac Surgery, Department of Surgery, Northwestern University, Chicago, Illinois
| | - Panos N Vardas
- Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
| | - A Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Thoralf M Sundt
- Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Vinay Badhwar
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia
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2
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Gaita F, Ferraris F, Anselmino M, Calò L. Atrial fibrillation fundamentals: from physiopathology to transcatheter ablation. Eur Heart J Suppl 2023; 25:C7-C11. [PMID: 37125271 PMCID: PMC10132612 DOI: 10.1093/eurheartjsupp/suad003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Atrial fibrillation (AF) is a common and harmful arrhythmia. Its complex pathogenesis can be outlined using Coumel's Triangle, that considers at the base of AF three different factors: substrate, trigger, and catalyst factor. The triangle can serve as a guide to understand the mechanism of action of the different possible treatments. Anti-arrhythmic drug therapies have a modest efficacy and no proven benefit on prognosis. Interventional therapy is more effective, especially if employed in the first stages of the disease, and can reduce mortality in selected populations. Ablative schemes must be different depending on the type of AF (paroxysmal, persistent) and the presence or absence of atrial dilation.
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Affiliation(s)
- Fiorenzo Gaita
- Corresponding author. Tel: +39 011 633 6767, Fax: +39 011 633 6769,
| | - Federico Ferraris
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza di Torino, Turin, Italy
| | - Matteo Anselmino
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza di Torino, University of Turin, Turin, Italy
| | - Leonardo Calò
- Division of Cardiology, Policlinico Casilino, Roma, Italy
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3
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Takagi T, Derval N, Duchateau J, Chauvel R, Tixier R, Marchand H, Bouyer B, André C, Kamakura T, Krisai P, Ascione C, Balbo C, Cheniti G, Denis A, Sacher F, Hocini M, Jaïs P, Haïssaguerre M, Pambrun T. Gaps after linear ablation of persistent atrial fibrillation (Marshall-PLAN): Clinical implication. Heart Rhythm 2023; 20:14-21. [PMID: 36115541 DOI: 10.1016/j.hrthm.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/30/2022] [Accepted: 09/09/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Beyond pulmonary vein (PV) isolation, anatomic isthmus transection is an adjunctive strategy for persistent atrial fibrillation. Data on the durability of multiple lines of block remain scarce. OBJECTIVE The purpose of this study was to evaluate the impact of gaps within such a lesion set. METHODS We followed 291 consecutive patients who underwent (1) vein of Marshall ethanol infusion, (2) PV isolation, and (3) mitral, cavotricuspid, and dome isthmus transection. Dome transection relied on 2 distinct strategies over time: a single roof line with touch-ups applied in case of gap demonstrated by conventional maneuvers (first leg), and an alternative floor line if the roof line exhibited a gap during high-density mapping with careful electrogram reannotation (second leg). RESULTS Twelve-month sinus rhythm maintenance was 70% after 1 procedure and 94% after 1 or 2 procedures. Event-free survival after the first procedure was lower in case of residual gaps within the lesion set (log-rank, P = .004). Delayed gaps were found in 94% of a second procedure performed in the 69 patients relapsing despite a complete lesion set with PV gaps increasing the risk of recurrence of atrial fibrillation (67% vs 34%; P = .02) and anatomic isthmus gaps supporting a majority of atrial tachycardias (60%). Between the first leg and the second leg, a significant decrease was found in roof lines considered blocked during the first procedure (99% vs 78%; P < .001) and in delayed dome gaps observed during a second procedure (68% vs 43%; P = .05). CONCLUSION Gaps are arrhythmogenic and can be reduced by optimized ablation and assessment of lines of block. Closing these gaps improves sinus rhythm maintenance.
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Affiliation(s)
- Takamitsu Takagi
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France.
| | - Nicolas Derval
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Josselin Duchateau
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Rémi Chauvel
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Romain Tixier
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Hugo Marchand
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Benjamin Bouyer
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Clémentine André
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Tsukasa Kamakura
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Philipp Krisai
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Ciro Ascione
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Conrado Balbo
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Ghassen Cheniti
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Arnaud Denis
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Frédéric Sacher
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Mélèze Hocini
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Pierre Jaïs
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Michel Haïssaguerre
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
| | - Thomas Pambrun
- Hôpital Cardiologique Haut-Lévêque, CHU de Bordeaux, L'Institut de RYthmologie et modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, France
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Yamashita S, Tokuda M, Mahida S, Sato H, Ikewaki H, Oseto H, Yokoyama M, Isogai R, Tokutake K, Yokoyama K, Narui R, Kato M, Tanigawa SI, Sugimoto KI, Yoshimura M, Yamane T. Very long term outcome after linear versus electrogram guided ablation for persistent atrial fibrillation. Sci Rep 2021; 11:23591. [PMID: 34880293 PMCID: PMC8654861 DOI: 10.1038/s41598-021-02935-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 11/22/2021] [Indexed: 11/10/2022] Open
Abstract
The optimal ablation strategy for persistent atrial fibrillation (PsAF) remains to be defined. We sought to compare very long-term outcomes between linear ablation and electrogram (EGM)-guided ablation for PsAF. In a retrospective analysis, long-term arrhythmia-free survival compared between two propensity-score matched cohorts, one with pulmonary vein isolation (PVI) and linear ablation including roof/mitral isthmus line (LINE-group, n = 52) and one with PVI and EGM-guided ablation (EGM-group; n = 52). Overall, 99% of patients underwent successful PVI. Complete block following linear ablation was achieved for 94% of roof lines and 81% of mitral lines (both lines blocked in 75%). AF termination by EGM-guided ablation was accomplished in 40% of patients. Non-PV foci were targeted in 7 (13%) in the LINE-group and 5 (10%) patients in the EGM-group (p = 0.76). During 100 ± 28 months of follow-up, linear ablation was associated with superior arrhythmia-free survival after the initial and last procedure (1.8 ± 0.9 procedures) compared with EGM-group (Logrank test: p = 0.0001 and p = 0.045, respectively). In multivariable analysis, longer AF duration and EGM-guided ablation remained as independent predictors of atrial arrhythmia recurrence. Linear ablation might be a more effective complementary technique to PVI than EGM-guided ablation for PsAF ablation.
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Affiliation(s)
- Seigo Yamashita
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-19-18 Nishishinbashi, Minato-ku, Tokyo, Japan.
| | - Michifumi Tokuda
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-19-18 Nishishinbashi, Minato-ku, Tokyo, Japan
| | - Saagar Mahida
- Department of Cardiac Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, UK
| | - Hidenori Sato
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-19-18 Nishishinbashi, Minato-ku, Tokyo, Japan
| | - Hirotsugu Ikewaki
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-19-18 Nishishinbashi, Minato-ku, Tokyo, Japan
| | - Hirotsuna Oseto
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-19-18 Nishishinbashi, Minato-ku, Tokyo, Japan
| | - Masaaki Yokoyama
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-19-18 Nishishinbashi, Minato-ku, Tokyo, Japan
| | - Ryota Isogai
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-19-18 Nishishinbashi, Minato-ku, Tokyo, Japan
| | - Kenichi Tokutake
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-19-18 Nishishinbashi, Minato-ku, Tokyo, Japan
| | - Kenichi Yokoyama
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-19-18 Nishishinbashi, Minato-ku, Tokyo, Japan
| | - Ryohsuke Narui
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-19-18 Nishishinbashi, Minato-ku, Tokyo, Japan
| | - Mika Kato
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-19-18 Nishishinbashi, Minato-ku, Tokyo, Japan
| | - Shin-Ichi Tanigawa
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-19-18 Nishishinbashi, Minato-ku, Tokyo, Japan
| | - Ken-Ichi Sugimoto
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-19-18 Nishishinbashi, Minato-ku, Tokyo, Japan
| | - Michihiro Yoshimura
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-19-18 Nishishinbashi, Minato-ku, Tokyo, Japan
| | - Teiichi Yamane
- Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, 3-19-18 Nishishinbashi, Minato-ku, Tokyo, Japan
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5
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Ji Y, He L, Cheng Z, Shi J, Liu L, Guo Y. Five-year follow-up report: Box lesion radiofrequency ablation procedure for atrial fibrillation under video-assisted thoracoscope. Clin Case Rep 2021; 9:e04837. [PMID: 34917358 PMCID: PMC8645180 DOI: 10.1002/ccr3.4837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/20/2021] [Accepted: 08/22/2021] [Indexed: 02/05/2023] Open
Abstract
We report the initial 5-year follow-up of a novel mini-invasive procedure for epicardial ablation for the treatment of atrial fibrillation. The initial 5-year survival rate is acceptable and comparable with that of hybrid ablation. And this shared procedure has the advantages of shorter operation time and less surgical trauma.
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Affiliation(s)
- Yupeng Ji
- Department of Cardiovascular SurgerySichuan University West China HospitalChengduChina
| | - Li He
- Department of Cardiovascular SurgerySichuan University West China HospitalChengduChina
| | - Zeyi Cheng
- Department of Cardiovascular SurgerySichuan University West China HospitalChengduChina
| | - Jun Shi
- Department of Cardiovascular SurgerySichuan University West China HospitalChengduChina
| | - Lulu Liu
- Department of Cardiovascular SurgerySichuan University West China HospitalChengduChina
| | - Yingqiang Guo
- Department of Cardiovascular SurgerySichuan University West China HospitalChengduChina
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6
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Gatti G, Fiorica I, Dell'Angela L, Morosin M, Faganello G, Cappelletto C, Pagura L, Ceschia A, Piazza R, Pappalardo A. Isolated left atrial cryoablation of atrial fibrillation in conventional mitral valve surgery. IJC HEART & VASCULATURE 2020; 31:100652. [PMID: 33102684 PMCID: PMC7575890 DOI: 10.1016/j.ijcha.2020.100652] [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: 05/28/2020] [Revised: 08/23/2020] [Accepted: 09/26/2020] [Indexed: 11/22/2022]
Abstract
BACKGROUND Recent trends of surgery for atrial fibrillation (AF) are towards more safe and effective energy sources, as well as to simplified sets of atrial lesions. METHODS One hundred eighteen (mean age, 67.4 ± 9.2 years) selected patients with paroxysmal/persistent AF and mitral valve (MV) disease underwent cryoablation of AF combined with conventional (not via mini-thoracotomy) MV surgery; the lesion set was limited to only the left atrium. Multivariable analyses identified predictors of cardiac rhythm at hospital discharge and follow-up. RESULTS There were 7 (5.9%) hospital deaths; 33 (28%) patients were discharged on AF. Higher values of preoperative left atrial volume index (odds ratio [OR] = 1.07, 95% confidence interval [95%CI]: 1.01-1.13) and mixed etiology of MV disease (OR = 4.19, 95%CI: 1.23-14.2) were predictors of hospital discharge on AF. Seventy-four (66.7%) patients were on stable sinus rhythm at follow-up (median period, 6.6 years); the 1, 5, and 10-year nonparametric estimates of adjusted freedom from AF were 98.1%, 89.2% and 45.6%, respectively. Higher values of preoperative systolic pulmonary artery pressure (hazard ratio [HR] = HR = 1.04, 95%CI: 1.01-1.08) and AF at hospital discharge (HR = 4.14, 95%CI: 1.50-11.4) were predictors of AF at follow-up. CONCLUSIONS During conventional MV surgery, a cryo-lesion set limited to only the left atrium may give good, immediate and long-term results. Left atrial dilation and mixed etiology of MV disease were predictors of hospital discharge on AF. Preoperative pulmonary hypertension and AF at discharge combined with an increased risk of AF at follow-up.
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Affiliation(s)
- Giuseppe Gatti
- Cardio-Thoracic & Vascular Department, Trieste University Hospital, Trieste, Italy
| | - Ilaria Fiorica
- Cardio-Thoracic & Vascular Department, Trieste University Hospital, Trieste, Italy
| | - Luca Dell'Angela
- Division of Cardiology, Gorizia & Monfalcone Hospital, Gorizia, Italy
| | - Marco Morosin
- Cardio-Thoracic & Vascular Department, Trieste University Hospital, Trieste, Italy
| | - Giorgio Faganello
- Cardio-Thoracic & Vascular Department, Trieste University Hospital, Trieste, Italy
| | - Chiara Cappelletto
- Department of Cardiology, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | - Linda Pagura
- Cardio-Thoracic & Vascular Department, Trieste University Hospital, Trieste, Italy
| | - Alessandro Ceschia
- Cardio-Thoracic & Vascular Department, Trieste University Hospital, Trieste, Italy
| | - Rita Piazza
- Department of Cardiology, Santa Maria degli Angeli Hospital, Pordenone, Italy
| | - Aniello Pappalardo
- Cardio-Thoracic & Vascular Department, Trieste University Hospital, Trieste, Italy
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7
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Houck CA, de Groot NMS, Kardys I, Niehot CD, Bogers AJJC, Mouws EMJP. Outcomes of Atrial Arrhythmia Surgery in Patients With Congenital Heart Disease: A Systematic Review. J Am Heart Assoc 2020; 9:e016921. [PMID: 32972303 PMCID: PMC7792370 DOI: 10.1161/jaha.120.016921] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background The improved life expectancy of patients with congenital heart disease is often accompanied by the development of atrial tachyarrhythmias. Similarly, the number of patients requiring redo operations is expected to continue to rise as these patients are aging. Consequently, the role of arrhythmia surgery in the treatment of atrial arrhythmias is likely to become more important in this population. Although atrial arrhythmia surgery is a well-established part of Fontan conversion procedures, evidence-based recommendations for arrhythmia surgery for macroreentrant atrial tachycardia and atrial fibrillation in other patients with congenital heart disease are still lacking. Methods and Results Twenty-eight studies were included in this systematic review. The median reported arrhythmia recurrence was 13% (interquartile range, 4%-26%) during follow-up ranging from 3 months to 15.2 years. A large variation in surgical techniques was observed. Based on the acquired data, biatrial lesions are more effective in the treatment of atrial fibrillation than exclusive right-sided lesions. Right-sided lesions may be more appropriate in the treatment of macroreentrant atrial tachycardia; evidence for the superiority of additional left-sided lesions is lacking. There are not enough data to support the use of exclusive left-sided lesions. Theoretically, prophylactic atrial arrhythmia surgery may be beneficial in this population, but evidence is currently limited. Conclusions To be able to provide recommendations for arrhythmia surgery in patients with congenital heart disease, future studies should report outcomes according to the type of preoperative arrhythmia, underlying congenital heart disease, lesion set, and energy source. This is essential for determining which surgical techniques should ideally be applied under which circumstances.
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Affiliation(s)
- Charlotte A Houck
- Department of Cardiology Erasmus MC University Medical Center Rotterdam Rotterdam the Netherlands.,Department of Cardiothoracic Surgery Erasmus MC University Medical Center Rotterdam Rotterdam the Netherlands
| | - Natasja M S de Groot
- Department of Cardiology Erasmus MC University Medical Center Rotterdam Rotterdam the Netherlands
| | - Isabella Kardys
- Department of Cardiology Erasmus MC University Medical Center Rotterdam Rotterdam the Netherlands
| | - Christa D Niehot
- Medical Library Erasmus MC University Medical Center Rotterdam Rotterdam the Netherlands
| | - Ad J J C Bogers
- Department of Cardiothoracic Surgery Erasmus MC University Medical Center Rotterdam Rotterdam the Netherlands
| | - Elisabeth M J P Mouws
- Department of Cardiothoracic Surgery Erasmus MC University Medical Center Rotterdam Rotterdam the Netherlands.,Department of Anesthesiology Amsterdam University Medical Center Amsterdam the Netherlands
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8
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R Schill M, S Cuculich P, M Andrews C, Vijayakumar R, Ruaengsri C, C Henn M, S Lancaster T, J Melby S, B Schuessler R, Rudy Y, J Damiano R. The Arrhythmic Substrate for Atrial Fibrillation in Patients with Mitral Regurgitation. J Atr Fibrillation 2020; 13:2304. [PMID: 34950292 DOI: 10.4022/jafib.2304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 03/30/2020] [Accepted: 04/07/2020] [Indexed: 11/10/2022]
Abstract
Objective Patients with severe mitral regurgitation commonly develop atrial fibrillation. The precise mechanisms of this relationship remain unknown. The objective of this study was to apply noninvasive electrocardiographic imaging of the atria during sinus rhythm to identify changes in atrial electrophysiology that may contribute to development of atrial fibrillation in patients with severe mitral regurgitation referred for mitral valve surgery. Methods Twenty subjects (9 atrial fibrillation and mitral regurgitation, 11 mitral regurgitation alone) underwent electrocardiographic imaging. Biatrial electrophysiology was imaged with activation maps in sinus rhythm. The reconstructed unipolar electrograms were analyzed for voltage amplitude, number of deflections and conduction heterogeneity. In subjects with mitral regurgitation, left atrial biopsies were obtained at the time of surgery. Results: Subjects with history of atrial fibrillation demonstrated prolonged left atrial conduction times (110±25 ms vs. mitral regurgitation alone (85±21), p=0.025); right atrial conduction times were unaffected. Variable patterns of conduction slowing were imaged in the left atria of most subjects, but those with prior history of atrial fibrillation had more complex patterns of conduction slowing or unidirectional block. The presence of atrial fibrillation was not associated with the extent of fibrosis in atrial biopsies. Conclusions Detailed changes in sinus rhythm atrial electrophysiology can be imaged noninvasively and can be used to assess the impact and evolution of atrial fibrillation on atrial conduction properties in patients with mitral regurgitation. If replicated in larger studies, electrocardiographic imaging may identify patients with mitral regurgitation at risk for atrial fibrillation and could be used to guide treatment strategies.
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Affiliation(s)
- Matthew R Schill
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University in St. Louis; 660 S. Euclid Ave., Campus Box 8234, St. Louis, MO 63110, USA
| | - Phillip S Cuculich
- Department of Medicine, Cardiovascular Division, Washington University in St. Louis; 660 S. Euclid Ave., Campus Box 8086, St. Louis, MO 63110, USA
| | - Christopher M Andrews
- Department of Biomedical Engineering, Washington University in St. Louis; 1 Brookings Dr., Campus Box 1097, St. Louis MO 63130, USA
| | - Ramya Vijayakumar
- Department of Biomedical Engineering, Washington University in St. Louis; 1 Brookings Dr., Campus Box 1097, St. Louis MO 63130, USA
| | - Chawannuch Ruaengsri
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University in St. Louis; 660 S. Euclid Ave., Campus Box 8234, St. Louis, MO 63110, USA
| | - Matthew C Henn
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University in St. Louis; 660 S. Euclid Ave., Campus Box 8234, St. Louis, MO 63110, USA
| | - Timothy S Lancaster
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University in St. Louis; 660 S. Euclid Ave., Campus Box 8234, St. Louis, MO 63110, USA
| | - Spencer J Melby
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University in St. Louis; 660 S. Euclid Ave., Campus Box 8234, St. Louis, MO 63110, USA
| | - Richard B Schuessler
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University in St. Louis; 660 S. Euclid Ave., Campus Box 8234, St. Louis, MO 63110, USA.,Department of Biomedical Engineering, Washington University in St. Louis; 1 Brookings Dr., Campus Box 1097, St. Louis MO 63130, USA
| | - Yoram Rudy
- Department of Medicine, Cardiovascular Division, Washington University in St. Louis; 660 S. Euclid Ave., Campus Box 8086, St. Louis, MO 63110, USA.,Department of Biomedical Engineering, Washington University in St. Louis; 1 Brookings Dr., Campus Box 1097, St. Louis MO 63130, USA
| | - Ralph J Damiano
- Department of Surgery, Division of Cardiothoracic Surgery, Washington University in St. Louis; 660 S. Euclid Ave., Campus Box 8234, St. Louis, MO 63110, USA
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9
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Mattia A, Newman J, Manetta F. Treatment Complications of Atrial Fibrillation and Their Management. Int J Angiol 2020; 29:98-107. [PMID: 32476810 DOI: 10.1055/s-0039-3401794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Atrial fibrillation (AF) is a rhythm disturbance defined by irregular, rapid electrical, and mechanical activation of the atria, which causes unsynchronized atrial contraction and promotes thromboembolism. AF is the most common sustained arrhythmia. Its prevalence and incidence are increasing due to aging and improved survival from acute heart diseases. This article is a review on AF management from both a surgical and catheter-based perspective. While both treatment approaches to AF have been shown to be successful in the management of AF, they are not without their own inherent complications. This article seeks to review some of these complications and help to guide treatment.
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Affiliation(s)
- Allan Mattia
- Department of Cardiovascular and Thoracic Surgery, Hofstra Northwell School of Medicine, Manhasset, New York
| | - Joshua Newman
- Department of Cardiovascular and Thoracic Surgery, Hofstra Northwell School of Medicine, Manhasset, New York
| | - Frank Manetta
- Department of Cardiovascular and Thoracic Surgery, Hofstra Northwell School of Medicine, Manhasset, New York
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Zhang D, Shi J, Quan H, Liu L, Zhang J, Guo Y. Five-year results of a modified left atrial maze IV procedure in the treatment of atrial fibrillation: a randomized study. ANZ J Surg 2019; 90:602-607. [PMID: 31742849 PMCID: PMC7217219 DOI: 10.1111/ans.15486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 08/28/2019] [Accepted: 08/29/2019] [Indexed: 02/05/2023]
Abstract
Background The left atrial maze IV (LAM‐IV) alone has been used to eliminate atrial fibrillation (AF) without severe right heart diseases. However, we felt that it could be improved and developed a modified LAM‐IV (MLAM‐IV). In this prospective trial, we aimed to investigate 5‐year clinical outcomes of AF in patients treated by the novel MLAM‐IV technique. Methods Between September 2012 and October 2013, 120 patients who underwent valve surgery and bipolar radiofrequency ablation for AF were randomized into the LAM‐IV group (n = 60) or MLAM‐IV group (n = 60). At postoperative follow‐up examinations, data were recorded at 1, 3 and 6 months, and annually thereafter. Results The mean ablation time and postoperative ventilation time were shorter in the MLAM‐IV group than in the LAM‐IV group (P < 0.001 and P = 0.03, respectively). At 5 years, the rate of freedom from AF was 69.0% in the MLAM‐IV group and 60.0% in the LAM‐IV group (hazard ratio 0.71, 95% confidence interval 0.39 to 1.32, P = 0.42). There were no differences with respect to the early operative mortality and major complications, late mortality, and major adverse events. Conclusions The MLAM‐IV provides a technically simpler ablation process. The MLAM‐IV was associated with less ventilation support in the early postoperative period. The long‐term efficacy of the MLAM‐IV in the treatment of AF is comparable to that of the LAM‐IV.
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Affiliation(s)
- Dengshen Zhang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jun Shi
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Huayan Quan
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Lu Liu
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jian Zhang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yingqiang Guo
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Mirror image technique for the thermal analysis in cryoablation: Experimental setup and validation. Cryobiology 2017; 79:56-64. [PMID: 28939114 DOI: 10.1016/j.cryobiol.2017.09.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 09/05/2017] [Accepted: 09/10/2017] [Indexed: 11/20/2022]
Abstract
The paper presents a set of experiments that were performed to characterize the freezing front propagation in water first, and in an agar-gel solution afterwards. The experimental setup made of Peltier devices, to emulate the cryogenic effect, and a copper cold finger, to mimic the cold probe interface, are described. We claim that by monitoring some temperatures at the generating cryodevice, several pieces of information can be derived through the cold interface to assess the outside thermodynamic changes. The employed technique, known as mirror image, allows determining the occurrence of the initial ice formation outside the cryo-probe and in the surrounding material, also with different magnitudes of the thermal contact resistance at the cold interface. For both water and agar the ice penetration was found to be non linear versus time, and proportional to the square root of time in the performed experiments. The ice drift velocity decreases according to its penetration inside the tested materials. At the beginning of ice formation, the measured drift velocities are approximately 0.11 mm/s and 0.06 mm/s for water and agar, respectively, and after the ice penetrates 2 mm, they become approximately 0.03 mm/s for both materials.
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Janotka M, Škoda J, Petrů J, Šedivá L, Chovanec M, Černý Š, Pavel P, Michel M, Skalský I, Benešová M, Neužil P. Arrhythmia recurrence in patients following cardiac surgery with concomitant therapy of atrial fibrillation - experience of our cardiac center. COR ET VASA 2017. [DOI: 10.1016/j.crvasa.2017.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Conduction recovery following catheter ablation in patients with recurrent atrial fibrillation and heart failure. Int J Cardiol 2017; 240:240-245. [PMID: 28258848 DOI: 10.1016/j.ijcard.2017.02.067] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 01/28/2017] [Accepted: 02/13/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) catheter ablation is increasingly proposed for patients suffering from AF and concomitant heart failure (HF). However, the optimal ablation strategy remains controversial. We performed this study to assess the prevalence of pulmonary vein (PV) or linear lesion reconnection in HF patients undergoing repeated procedures. METHODS AND RESULTS At seven high-volume centres, 165 patients with HF underwent a repeat procedure after a first AF ablation including PV isolation alone (47 patients, group A) or PV isolation plus left atrial lines (118 patients, group B). Group A patients presented more often paroxysmal AF (p<0.001), less enlarged left atrium (p<0.001) and less left ventricular systolic dysfunction (p=0.031) compared to Group B, that more commonly had atypical atrial flutter (p<0.001). Forty-one (87%) patients in Group A and 69 (58%) in Group B presented at least one reconnected PV (p<0.001). Sixty-one (52%) patients in Group B presented at least one reconnected atrial line (left isthmus or roof). Patients without any reconnected PV (n=54, 33%) more frequently experienced persistent AF (p<0.001), had longer AF duration (p=0.047) and larger left atrial volume (p<0.001). Twenty-five patients (15%) with no PV and/or line reconnection did not significantly differ, concerning baseline characteristics, compared to those with at least one reconnected ablation site. CONCLUSION As in the general AF population undergoing catheter ablation, PV reconnection is frequent in patients with HF and symptomatic recurrence. However, one third of patients presented arrhythmic recurrences even in the absence of PV reconnection, highlighting the importance of the underlying atrial substrate.
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The Society of Thoracic Surgeons 2017 Clinical Practice Guidelines for the Surgical Treatment of Atrial Fibrillation. Ann Thorac Surg 2017; 103:329-341. [PMID: 28007240 DOI: 10.1016/j.athoracsur.2016.10.076] [Citation(s) in RCA: 339] [Impact Index Per Article: 48.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 10/12/2016] [Indexed: 02/08/2023]
Abstract
EXECUTIVE SUMMARY Surgical ablation for atrial fibrillation (AF) can be performed without additional risk of operative mortality or major morbidity, and is recommended at the time of concomitant mitral operations to restore sinus rhythm. (Class I, Level A) Surgical ablation for AF can be performed without additional operative risk of mortality or major morbidity, and is recommended at the time of concomitant isolated aortic valve replacement, isolated coronary artery bypass graft surgery, and aortic valve replacement plus coronary artery bypass graft operations to restore sinus rhythm. (Class I, Level B nonrandomized) Surgical ablation for symptomatic AF in the absence of structural heart disease that is refractory to class I/III antiarrhythmic drugs or catheter-based therapy or both is reasonable as a primary stand-alone procedure, to restore sinus rhythm. (Class IIA, Level B randomized) Surgical ablation for symptomatic persistent or longstanding persistent AF in the absence of structural heart disease is reasonable, as a stand-alone procedure using the Cox-Maze III/IV lesion set compared with pulmonary vein isolation alone. (Class IIA, Level B nonrandomized) Surgical ablation for symptomatic AF in the setting of left atrial enlargement (≥4.5 cm) or more than moderate mitral regurgitation by pulmonary vein isolation alone is not recommended. (Class III no benefit, Level C expert opinion) It is reasonable to perform left atrial appendage excision or exclusion in conjunction with surgical ablation for AF for longitudinal thromboembolic morbidity prevention. (Class IIA, Level C limited data) At the time of concomitant cardiac operations in patients with AF, it is reasonable to surgically manage the left atrial appendage for longitudinal thromboembolic morbidity prevention. (Class IIA, Level C expert opinion) In the treatment of AF, multidisciplinary heart team assessment, treatment planning, and long-term follow-up can be useful and beneficial to optimize patient outcomes. (Class I, Level C expert opinion).
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Marchetto G, Anselmino M, Rovera C, Mancuso S, Ricci D, Antolini M, Morello M, Gaita F, Rinaldi M. Results of Cryoablation for Atrial Fibrillation Concomitant With Video-Assisted Minimally Invasive Mitral Valve Surgery. Semin Thorac Cardiovasc Surg 2017; 28:271-280. [PMID: 28043429 DOI: 10.1053/j.semtcvs.2016.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2016] [Indexed: 11/11/2022]
Abstract
Interest in minimally invasive video-assisted mitral valve surgery (MIMVS) is rapidly growing. Data on concomitant atrial fibrillation (AF) ablation to MIMVS are still lacking. The present study investigates the long-term results of AF cryoablation concomitant to MIMVS. From October 2006-September 2014, 68 patients with mitral valve disease (age 65.9 ± 11.1 years, 34 men out of 68 patients, Euroscore log 5.4 ± 4.5) and drug-resistant AF underwent MIMVS via right minithoracotomy and concomitant left-sided AF endocardial cryoablation (Cryoflex Medtronic, Minneapolis, MN). Patients were independently followed up by cardiological outpatient visits and underwent electrophysiological study when indicated. In total, 44 out of 68 patients (64.7%) underwent mitral valve repair and 8 patients (11.8%) also received concomitant tricuspid valve surgery. One procedure was electively converted to full sternotomy (1.5%). Total clamp time was 97.6 ± 22.8 minutes. In March 2015, 60 patients were alive and completed the follow-up after a mean of 3.4 ± 2.0 years following the procedure. In all, 48 patients (80%) presented sinus rhythm throughout the whole follow-up. Freedom from AF was respectively 95%, 87%, and 72% at 1, 3, and 5 years, respectively. We recorded 2 pacemaker implants (3.3%). A total of 3 patients suffered symptomatic recurrences (2 atypical atrial flutter and 1 atrial fibrillation) and underwent transcatheter ablation-all the 3 patients remained in stable sinus rhythm for the remaining follow-up. In conclusions, given the favorable long-term sinus rhythm maintenance rates of concomitant cryoablation, MIMVS can also be offered to patients with symptomatic AF. AF transcatheter ablation may easily avoid further symptomatic recurrences.
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Affiliation(s)
- Giovanni Marchetto
- Department of Surgical Sciences, Città della Salute e della Scienza di Torino Hospital, University of Turin, Turin, Italy; Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, University of Turin, Turin, Italy.
| | - Matteo Anselmino
- Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, University of Turin, Turin, Italy
| | - Chiara Rovera
- Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, University of Turin, Turin, Italy
| | - Samuel Mancuso
- Department of Surgical Sciences, Città della Salute e della Scienza di Torino Hospital, University of Turin, Turin, Italy; Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, University of Turin, Turin, Italy
| | - Davide Ricci
- Department of Surgical Sciences, Città della Salute e della Scienza di Torino Hospital, University of Turin, Turin, Italy; Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, University of Turin, Turin, Italy
| | - Marina Antolini
- Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, University of Turin, Turin, Italy
| | - Mara Morello
- Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, University of Turin, Turin, Italy
| | - Fiorenzo Gaita
- Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, University of Turin, Turin, Italy
| | - Mauro Rinaldi
- Department of Surgical Sciences, Città della Salute e della Scienza di Torino Hospital, University of Turin, Turin, Italy; Department of Medical Sciences, Città della Salute e della Scienza di Torino Hospital, University of Turin, Turin, Italy
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Maesen B, Van-Loo I, Pison L, La-Meir M. Surgical Ablation of Atrial Fibrillation: is Electrical Isolation of the Pulmonary Veins a Must? J Atr Fibrillation 2016; 9:1426. [PMID: 27909520 DOI: 10.4022/jafib.1426] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 04/23/2016] [Accepted: 04/23/2016] [Indexed: 11/10/2022]
Abstract
Ablation of atrial fibrillation (AF) is a well-established treatment option for patients with symptomatic AF refractory to antiarrhythmic drugs. The cornerstone of catheter ablation is electrical isolation of the pulmonary veins, since the pulmonary veins are the most common location for triggers of AF. Electrical reconnection of the pulmonary veins is associated with arrhythmia recurrence and therefore diminishes long-term success of catheter ablation of AF. Therefore, durable pulmonary vein isolation remains a condition sine qua non for catheter ablation of AF. The Cox-Maze procedure is considered an effective surgical cure of AF, however it has never been widely adopted due to its procedural complexity. Since the development of minimal invasive techniques for surgical AF treatment, surgical ablation of AF has regained interest. Most of the minimal invasive surgical AF ablations performed around the globe include pulmonary vein isolation as a part of the procedure. In this review, we explore the necessity of electrical isolation of the pulmonary veins in surgical AF ablation.
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Affiliation(s)
- Bart Maesen
- Department of Cardio-Thoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ines Van-Loo
- Department of Cardiac Surgery, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Laurent Pison
- Department of Cardiology, aastricht University Medical Center, Maastricht, The Netherlands
| | - Mark La-Meir
- Department of Cardio-Thoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Cardiac Surgery, Universitair Ziekenhuis Brussel, Brussels, Belgium
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Uribe-Arango W, Duque-Ramírez M, Velásquez-Vélez JE, Aristizábal-Aristizábal JM, Marín-Velásquez JE, Díaz-Martínez JC. Crioablación con balón en fibrilación auricular. REVISTA COLOMBIANA DE CARDIOLOGÍA 2016. [DOI: 10.1016/j.rccar.2016.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Huffman MD, Karmali KN, Berendsen MA, Andrei A, Kruse J, McCarthy PM, Malaisrie SC. Concomitant atrial fibrillation surgery for people undergoing cardiac surgery. Cochrane Database Syst Rev 2016; 2016:CD011814. [PMID: 27551927 PMCID: PMC5046840 DOI: 10.1002/14651858.cd011814.pub2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND People with atrial fibrillation (AF) often undergo cardiac surgery for other underlying reasons and are frequently offered concomitant AF surgery to reduce the frequency of short- and long-term AF and improve short- and long-term outcomes. OBJECTIVES To assess the effects of concomitant AF surgery among people with AF who are undergoing cardiac surgery on short-term and long-term (12 months or greater) health-related outcomes, health-related quality of life, and costs. SEARCH METHODS Starting from the year when the first "maze" AF surgery was reported (1987), we searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library (March 2016), MEDLINE Ovid (March 2016), Embase Ovid (March 2016), Web of Science (March 2016), the Database of Abstracts of Reviews of Effects (DARE, April 2015), and Health Technology Assessment Database (HTA, March 2016). We searched trial registers in April 2016. We used no language restrictions. SELECTION CRITERIA We included randomised controlled trials evaluating the effect of any concomitant AF surgery compared with no AF surgery among adults with preoperative AF, regardless of symptoms, who were undergoing cardiac surgery for another indication. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies and extracted data. We evaluated the risk of bias using the Cochrane 'Risk of bias' tool. We included outcome data on all-cause and cardiovascular-specific mortality, freedom from atrial fibrillation, flutter, or tachycardia off antiarrhythmic medications, as measured by patient electrocardiographic monitoring greater than three months after the procedure, procedural safety, 30-day rehospitalisation, need for post-discharge direct current cardioversion, health-related quality of life, and direct costs. We calculated risk ratios (RR) for dichotomous data with 95% confidence intervals (CI) using a fixed-effect model when heterogeneity was low (I² ≤ 50%) and random-effects model when heterogeneity was high (I² > 50%). We evaluated the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework to create a 'Summary of findings' table. MAIN RESULTS We found 34 reports of 22 trials (1899 participants) with five additional ongoing studies and three studies awaiting classification. All included studies were assessed as having high risk of bias across at least one domain. The effect of concomitant AF surgery on all-cause mortality was uncertain when compared with no concomitant AF surgery (7.0% versus 6.6%, RR 1.14, 95% CI 0.81 to 1.59, I² = 0%, 20 trials, 1829 participants, low-quality evidence), but the intervention increased freedom from atrial fibrillation, atrial flutter, or atrial tachycardia off antiarrhythmic medications > three months (51.0% versus 24.1%, RR 2.04, 95% CI 1.63 to 2.55, I² = 0%, eight trials, 649 participants, moderate-quality evidence). The effect of concomitant AF surgery on 30-day mortality was uncertain (2.3% versus 3.1%, RR 1.25 95% CI 0.71 to 2.20, I² = 0%, 18 trials, 1566 participants, low-quality evidence), but the intervention increased the risk of permanent pacemaker implantation (6.0% versus 4.1%, RR 1.69, 95% CI 1.12 to 2.54, I² = 0%, 18 trials, 1726 participants, moderate-quality evidence). Investigator-defined adverse events, including but limited to, need for surgical re-exploration or mediastinitis, were not routinely reported but were not different between the two groups (other adverse events: 24.8% versus 23.6%, RR 1.07, 95% CI 0.85 to 1.34, I² = 45%, nine trials, 858 participants), but the quality of this evidence was very low. AUTHORS' CONCLUSIONS For patients with AF undergoing cardiac surgery, there is moderate-quality evidence that concomitant AF surgery approximately doubles the risk of freedom from atrial fibrillation, atrial flutter, or atrial tachycardia off anti-arrhythmic drugs while increasing the risk of permanent pacemaker implantation. The effects on mortality are uncertain. Future, high-quality and adequately powered trials will likely affect the confidence on the effect estimates of AF surgery on clinical outcomes.
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Affiliation(s)
- Mark D Huffman
- Northwestern University Feinberg School of MedicineDepartments of Preventive Medicine and Medicine (Cardiology)680 N. Lake Shore Drive, Suite 1400ChicagoILUSA60611
| | - Kunal N Karmali
- Northwestern University Feinberg School of MedicineDepartments of Medicine (Cardiology)ChicagoILUSA60611
| | - Mark A Berendsen
- Northwestern UniversityGalter Health Sciences Library303 E. Chicago AvenueChicagoILUSA60611
| | - Adin‐Cristian Andrei
- Northwestern UniversityDepartment of Surgery676 N.Saint Clair St.Suite 1700ChicagoILUSA60611
| | - Jane Kruse
- Northwestern MedicineBluhm Cardiovascular Institute201 East Huron, Galter 11‐140ChicagoILUSA60611
| | - Patrick M McCarthy
- Northwestern UniversityDivision of Cardiac Surgery201 E. Huron StreetGalter 11‐140ChicagoILUSA60611
| | - S. Chris Malaisrie
- Northwestern UniversityDivision of Cardiac Surgery201 E. Huron StreetGalter 11‐140Chicago, ILUSA60611
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Shi J, Bai ZX, Zhang BG, Ren WJ, Guo YQ. A modified Cox maze IV procedure: a simpler technique for the surgical treatment of atrial fibrillation. Interact Cardiovasc Thorac Surg 2016; 23:856-860. [PMID: 27521177 DOI: 10.1093/icvts/ivw256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 05/19/2016] [Accepted: 05/26/2016] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES To determine the effectiveness of a simplified surgical treatment method for atrial fibrillation (AF). METHODS Between September 2012 and October 2013, 120 patients (mean age, 52.3 ± 8.8 years) underwent valve surgery and concomitant bipolar radiofrequency ablation for the treatment of AF. Patients were randomized to a Cox maze IV procedure (CMP-IV) group (n = 60) or a modified CMP-IV (MCMP-IV) group (n = 60). Freedom from AF was defined as freedom from any left atrial arrhythmia lasting <30 s and no requirement of antiarrhythmic drugs after 6 months. Data were recorded at postoperative follow-up examinations, which were scheduled at 1, 3, 6 and 12 months, and annually thereafter. RESULTS No ablation-related complications occurred in either group. The mean ablation time was longer in the CMP-IV group than in the MCMP-IV group (18.5 ± 1.7 vs 16.6 ± 1.6 min, P < 0.001). The mean follow-up time was 32.4 ± 3.6 months (range, 26-39 months). Freedom from AF tended to be higher, but not significantly so, among the MCMP-IV group than among the CMP-IV group over the entire follow-up period. CONCLUSIONS The MCMP-IV is an effective surgical procedure for the treatment of AF. In certain patients, such as those with anatomic variations of the pulmonary veins, the MCMP-IV is simpler than the CMP-IV. CLINICAL TRIALS REGISTRATION ID ChiCTR-TRC-12002742.
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Affiliation(s)
- Jun Shi
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhi-Xuan Bai
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ben-Gui Zhang
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wen-Jun Ren
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ying-Qiang Guo
- Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Tiwari KK, Gasbarri T, Bevilacqua S, Glauber M. Right-Sided Minithoracotomy as a Surgical Approach for the Concomitant Treatment of Atrial Fibrillation. Res Cardiovasc Med 2016; 5:e31374. [PMID: 26949690 PMCID: PMC4756228 DOI: 10.5812/cardiovascmed.31374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 09/20/2015] [Accepted: 09/20/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is the most common arrhythmia diagnosed in humans and therefore causes a high socioeconomic burden. The Cox-Maze IV procedure is the gold standard treatment for atrial fibrillation. Minimally invasive surgery for the treatment of AF is also promising. OBJECTIVES Our aim is to evaluate the feasibility, safety, and immediate plus medium-term results of concomitant AF ablation therapy in patients undergoing minimally invasive valve surgery through right-sided minithoracotomy. PATIENTS AND METHODS Retrospective data were collected from January 2012 to December 2013. Seventy-five consecutive patients underwent radiofrequency ablation during valve surgery through a right-sided minithoracotomy. RESULTS All 75 patients underwent radiofrequency ablation. The pulmonary vein was isolated in 6 (8%) by encircling the left and right pulmonary veins. In 9 (12%) patients, endocardial box lesions were created using a monopolar probe, while in 47 (62.7%), epicardial box lesions were produced with a monopolar probe. Thirteen (17.3%) patients received a box lesion created with a bipolar probe. Finally, in 22 (29.3%) patients, a line of lesions was produced leading up to the posterior mitral annulus. Only 1 (1.3%) perioperative death was observed. At discharge, 43 (57.3%) patients were in sinus rhythm and 30 (40%) were in AF. After a mean follow-up of 21.6 ± 10.1 months, 46 patients (63%) were in a stable sinus rhythm and 27 were in (37%) in AF; 26 (56.5%) patients were free from antiarrhythmic therapy, while 19 (42.2%) were still taking at least one drug. CONCLUSIONS We can conclude that treatment of AF using a right-sided minithoracotomy approach and RF energy in patients undergoing cardiac surgery for various valve diseases is feasible, safe, and reproducible.
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Affiliation(s)
- Kaushal Kishore Tiwari
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Massa, Italy
- Department of Cardiothoracic and Vascular Surgery, College of Medical Sciences, Teaching Hospital, Kathmandu University, Bharatpur, Nepal
- Corresponding author: Kaushal Kishore Tiwari, Department of Cardiothoracic and Vascular Surgery, College of Medical Sciences, Teaching Hospital, Kathmandu University, Bharatpur, Nepal. Tel: +977-9801059361, Fax: +977-56525012, E-mail:
| | - Tommaso Gasbarri
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Massa, Italy
| | - Stefano Bevilacqua
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Massa, Italy
| | - Mattia Glauber
- Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Massa, Italy
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Raiten JM, Ghadimi K, Augoustides JGT, Ramakrishna H, Patel PA, Weiss SJ, Gutsche JT. Atrial fibrillation after cardiac surgery: clinical update on mechanisms and prophylactic strategies. J Cardiothorac Vasc Anesth 2016; 29:806-16. [PMID: 26009291 DOI: 10.1053/j.jvca.2015.01.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Indexed: 11/11/2022]
Affiliation(s)
- Jesse M Raiten
- Cardiovascular Critical Care Section, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Kamrouz Ghadimi
- Division of CT Anesthesiology and Critical Care Medicine, Department of Anesthesiology, School of Medicine, Duke University, Durham, NC
| | - John G T Augoustides
- Cardiovascular and Thoracic Section, Departmsent of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | | | - Prakash A Patel
- Cardiovascular and Thoracic Section, Departmsent of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Stuart J Weiss
- Cardiovascular and Thoracic Section, Departmsent of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jacob T Gutsche
- Cardiovascular and Thoracic Section, Departmsent of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Gaita F, Castagno D. Electrophysiologically Guided Substrate Modification During Sinus Rhythm: Personalized Approach to Nonparoxysmal Atrial Fibrillation. Circ Arrhythm Electrophysiol 2016; 9:e003832. [PMID: 26857910 DOI: 10.1161/circep.116.003832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Fiorenzo Gaita
- From the Division of Cardiology, Department of Medical Sciences, "Città della Salute e della Scienza" Hospital, University of Turin, Turin, Italy.
| | - Davide Castagno
- From the Division of Cardiology, Department of Medical Sciences, "Città della Salute e della Scienza" Hospital, University of Turin, Turin, Italy
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Choi JY, Park EJ, Kim HD, Park SH, Song JY, Lee DI, Shim J, Kim YH. Ethanol Infusion in the Vein of Marshall in a Patient with Persistent Atrial Fibrillation. Korean Circ J 2015; 45:424-7. [PMID: 26413111 PMCID: PMC4580702 DOI: 10.4070/kcj.2015.45.5.424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2014] [Revised: 10/16/2014] [Accepted: 10/28/2014] [Indexed: 11/11/2022] Open
Abstract
We report the case of a 64-year-old male with persistent atrial fibrillation (AF) terminated by ethanol infusion into vein of Marshall as add-on therapy. Three-dimensional automated complex fractionated atrial electrogram (CFAE) during AF revealed clustering of CFAE at perimitral isthmus (PMI) and its unipolar mapping showed rotor-like activation, which was suggested to be critical in the perpetuation of AF. AF was organized to atrial tachycardia (AT) by 100% ethanol infusion in the vein of Marshall. Adjunctive radiofrequency ablation at PMI successfully terminated AT and led to bidirectional block of PMI.
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Affiliation(s)
- Jah Yeon Choi
- Department of Cardiology, Korea University College of Medicine, Anam Hospital, Seoul, Korea
| | - Eun Jin Park
- Department of Cardiology, Korea University College of Medicine, Anam Hospital, Seoul, Korea
| | - Hee Dong Kim
- Department of Cardiology, Korea University College of Medicine, Anam Hospital, Seoul, Korea
| | - Sung Hun Park
- Department of Cardiology, Korea University College of Medicine, Anam Hospital, Seoul, Korea
| | - Ji Young Song
- Department of Cardiology, Korea University College of Medicine, Anam Hospital, Seoul, Korea
| | - Dae In Lee
- Department of Cardiology, Korea University College of Medicine, Anam Hospital, Seoul, Korea
| | - Jaemin Shim
- Department of Cardiology, Korea University College of Medicine, Anam Hospital, Seoul, Korea
| | - Young-Hoon Kim
- Department of Cardiology, Korea University College of Medicine, Anam Hospital, Seoul, Korea
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Ramlawi B, Bedeir K. Surgical options in atrial fibrillation. J Thorac Dis 2015; 7:204-13. [PMID: 25713738 DOI: 10.3978/j.issn.2072-1439.2014.12.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Accepted: 11/14/2014] [Indexed: 11/14/2022]
Abstract
Atrial fibrillation (AF) is not benign and its prevalence is increasing. The two main goals in management of atrial fibrillation are to optimize hemodynamics through rate or rhythm control and to prevent systemic thrombo-embolism. To date, these two goals are still sub-optimally achieved, raising the need for alternative methods and strategies both pharmacologically and through interventions. In this review, we discuss surgical strategies of achieving both goals with insights on the evolution and potential future of these strategies.
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Affiliation(s)
- Basel Ramlawi
- Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Kareem Bedeir
- Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
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25
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Garcia R, Sacher F, Oses P, Derval N, Barandon L, Denis A, Hocini M, Roques X, Haïssaguerre M, Labrousse L, Jaïs P. Electrophysiological study 6 months after Epicor™ high-intensity focused ultrasound atrial fibrillation ablation. J Interv Card Electrophysiol 2014; 41:245-51. [DOI: 10.1007/s10840-014-9949-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Accepted: 09/01/2014] [Indexed: 10/24/2022]
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Gillinov M, Soltesz E. Surgical treatment of atrial fibrillation: today's questions and answers. Semin Thorac Cardiovasc Surg 2014; 25:197-205. [PMID: 24331141 DOI: 10.1053/j.semtcvs.2013.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/17/2013] [Indexed: 11/11/2022]
Abstract
Although atrial fibrillation is common in cardiac surgery patients, the Cox maze IV procedure is underutilized; in contemporary practice, most cardiac surgery patients with atrial fibrillation do not receive concomitant surgical ablation. Available evidence suggests that a biatrial, energy-assisted Cox maze IV procedure restores normal sinus rhythm in two-thirds to three-quarters of patients without increasing operative risk. The best results are obtained by adherence to the correct lesion set and careful attention to perioperative management of heart rhythm and anticoagulation. To date, we have no randomized clinical trials confirming that surgical ablation improves clinical outcomes beyond restoration of sinus rhythm; however, available evidence does suggest that concomitant surgical ablation provides clinical benefit, most notably by reducing the long-term risk of stroke.
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Affiliation(s)
- Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio..
| | - Edward Soltesz
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio
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27
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Anselmino M, Ferraris F, Cerrato N, Barbero U, Scaglione M, Gaita F. Left persistent superior vena cava and paroxysmal atrial fibrillation. J Cardiovasc Med (Hagerstown) 2014; 15:647-52. [DOI: 10.2459/jcm.0000000000000144] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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HUO YAN, SCHOENBAUER ROBERT, RICHTER SERGIO, ROLF SASCHA, SOMMER PHILIPP, ARYA ARASH, RASTAN ARDAWAN, DOLL NICOLAS, MOHR FRIEDRICHWILHELM, HINDRICKS GERHARD, PIORKOWSKI CHRISTOPHER, GASPAR THOMAS. Atrial Arrhythmias Following Surgical AF Ablation: Electrophysiological Findings, Ablation Strategies, and Clinical Outcome. J Cardiovasc Electrophysiol 2014; 25:725-38. [DOI: 10.1111/jce.12406] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2013] [Revised: 02/13/2014] [Accepted: 02/17/2014] [Indexed: 11/30/2022]
Affiliation(s)
- YAN HUO
- Department of Electrophysiology; Dresden University-Heart Center; Dresden Germany
| | - ROBERT SCHOENBAUER
- Department of Electrophysiology; Leipzig University-Heart Center; Leipzig Germany
| | - SERGIO RICHTER
- Department of Electrophysiology; Leipzig University-Heart Center; Leipzig Germany
| | - SASCHA ROLF
- Department of Electrophysiology; Leipzig University-Heart Center; Leipzig Germany
| | - PHILIPP SOMMER
- Department of Electrophysiology; Leipzig University-Heart Center; Leipzig Germany
| | - ARASH ARYA
- Department of Electrophysiology; Leipzig University-Heart Center; Leipzig Germany
| | - ARDAWAN RASTAN
- Department of Cardiac Surgery; Rotenburg a. d. Fulda; Germany
| | - NICOLAS DOLL
- Department of Cardiac Surgery; Sana Hospital; Stuttgart Germany
| | | | - GERHARD HINDRICKS
- Department of Electrophysiology; Leipzig University-Heart Center; Leipzig Germany
| | | | - THOMAS GASPAR
- Department of Electrophysiology; Dresden University-Heart Center; Dresden Germany
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29
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Robertson JO, Saint LL, Leidenfrost JE, Damiano RJ. Illustrated techniques for performing the Cox-Maze IV procedure through a right mini-thoracotomy. Ann Cardiothorac Surg 2014; 3:105-16. [PMID: 24516807 DOI: 10.3978/j.issn.2225-319x.2013.12.11] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2013] [Accepted: 12/28/2013] [Indexed: 11/14/2022]
Abstract
The Cox-Maze IV procedure has replaced the "cut-and-sew" technique of the original Cox-Maze operation with lines of ablation created using bipolar radiofrequency (RF) and cryothermal energy devices. In select patients, this procedure can be performed through a right mini-thoracotomy. This illustrated review is the first to detail the complete steps of the Cox-Maze IV procedure performed through a right mini-thoracotomy with careful attention paid to operative anatomy and advice. Pre- and post-operative management and outcomes are also discussed. This should be a practical guide for the practicing cardiac surgeon.
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Affiliation(s)
- Jason O Robertson
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | - Lindsey L Saint
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | - Jeremy E Leidenfrost
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
| | - Ralph J Damiano
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis, MO, USA
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Bertaglia E, Stabile G, Senatore G, Pratola C, Verlato R, Lowe M, Raatikainen P, Lamberti F, Turco P. Documentation of pulmonary vein isolation improves long term efficacy of persistent atrial fibrillation catheter ablation. Int J Cardiol 2013; 171:174-8. [PMID: 24393576 DOI: 10.1016/j.ijcard.2013.11.055] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Revised: 10/22/2013] [Accepted: 11/23/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND The aim of this study was to investigate the efficacy of catheter ablation in the treatment of persistent atrial fibrillation (AF) and the predictors of arrhythmia recurrence. METHODS Absence of atrial tachyarrhythmia (AT) recurrence during a mid-term follow-up was correlated with several clinical and procedural characteristics in a population of 82 patients aged 20-70 years who had experienced at least one documented relapse of persistent AF during a single trial of antiarrhythmic drug therapy. Electrophysiological success of ablation was declared when all identified PVs were isolated (confirmation of entry and exit block). Patients were followed for a maximum of 24 months after the blanking period with outpatient visits, ECG recordings, 24-hour Holter monitoring, and weekly transtelephonic monitoring for 30s. RESULTS Electrophysiological success was documented in 38/82 (46.3%) patients. During a mean follow-up of 24.7 ± 4.2 months, 69/82 (84.1%) patients presented at least one episode of AT after the 2 month blanking period. According to univariate and multivariate logistic regression analyses, only an electrophysiologically successful ablation significantly correlated with the absence of documented AT relapse (OR 5.32, 95% CL 1.02-27.72; p=.0472). CONCLUSIONS Mid-term outcome of a single procedure of catheter ablation without the adjunction of antiarrhythmic drug therapy is poor in patients with persistent AF. Documented PV isolation is useful to increase the success rate of circumferential PV ablation even in persistent AF patients.
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Affiliation(s)
- Emanuele Bertaglia
- Department of Cardiological, Thoracic, and Vascular Sciences, University of Padua, Padova, Italy.
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Nakamura K, Funabashi N, Naito S, Uehara M, Takaoka H, Kaseno K, Kumagai K, Oshima S, Kobayashi Y. Anatomical relationship of coronary sinus/great cardiac vein and left circumflex coronary artery along mitral annulus in atrial fibrillation before radiofrequency catheter ablation using 320-slice CT. Int J Cardiol 2013; 168:5174-81. [DOI: 10.1016/j.ijcard.2013.07.261] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 07/20/2013] [Indexed: 10/26/2022]
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Gaita F, Ebrille E, Scaglione M, Caponi D, Garberoglio L, Vivalda L, Barbone A, Gallotti R. Very long-term results of surgical and transcatheter ablation of long-standing persistent atrial fibrillation. Ann Thorac Surg 2013; 96:1273-1278. [PMID: 23915587 DOI: 10.1016/j.athoracsur.2013.05.054] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2013] [Revised: 05/16/2013] [Accepted: 05/17/2013] [Indexed: 12/27/2022]
Abstract
BACKGROUND New hybrid approaches for atrial fibrillation (AF) ablation, combining surgical and percutaneous procedures, are emerging to enhance the long-term success rate of these 2 procedures severally considered. Recent guidelines underline the need for long-term follow-up to really assess the efficacy of AF ablation. METHODS From 2000 to 2002, 33 patients with long-standing persistent AF and valvular heart disease underwent valve surgery and cryoablation (pulmonary veins isolation and mitral isthmus and roof line lesions). The surgically created ablation scheme was validated with electroanatomic mapping and percutaneous radiofrequency ablation was performed in case of lesion incompleteness. RESULTS In 19 of 33 patients (58%) the electroanatomic mapping showed a complete lesion scheme, which increased to 79% (26 of 33) with the addition of radiofrequency ablation. At the mean follow-up of 10.7 ± 3.1 years, 73% (24 of 33) of patients were in sinus rhythm (SR), whereas 27% had permanent AF. At the end of follow-up 81% of patients with a complete lesion scheme were in SR, while 43% with an incomplete one maintained SR (p = 0.048). CONCLUSIONS In patients with long-standing persistent AF and valvular heart disease, the hybrid approach with surgical cryoablation consisting of pulmonary veins isolation and left atrial linear lesions combined with transcatheter radiofrequency ablation was highly effective in maintaining SR for a very long-term follow-up. Electrophysiological evaluation, to validate the transmurality of the surgical lesions and to complete the lesion scheme applying radiofrequency energy, improved the long-term efficacy.
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Affiliation(s)
- Fiorenzo Gaita
- Department of Cardiology, School of Medicine, University of Turin, Turin, Italy.
| | - Elisa Ebrille
- Department of Cardiology, School of Medicine, University of Turin, Turin, Italy
| | - Marco Scaglione
- Department of Cardiology, Cardinal Massaia Hospital, Asti, Italy
| | - Domenico Caponi
- Department of Cardiology, Cardinal Massaia Hospital, Asti, Italy
| | | | - Laura Vivalda
- Department of Cardiology, Cardinal Massaia Hospital, Asti, Italy
| | - Alessandro Barbone
- Department of Cardiac Surgery, Istituto Clinico Humanitas IRCCS, Rozzano, Italy
| | - Roberto Gallotti
- Department of Cardiac Surgery, Istituto Clinico Humanitas IRCCS, Rozzano, Italy
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Herzchirurgische Therapie von Vorhofflimmern. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2013. [DOI: 10.1007/s00398-012-0948-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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KOMATSU YUKI, TANIGUCHI HIROSHI, MIYAZAKI SHINSUKE, NAKAMURA HIROAKI, KUSA SHIGEKI, UCHIYAMA TAKASHI, KAKITA KEN, KAKUTA TSUNEKAZU, HACHIYA HITOSHI, IESAKA YOSHITO. Impact of Atrial Fibrillation Termination on Clinical Outcome after Ablation in Relation to the Duration of Persistent Atrial Fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2012; 35:1436-43. [DOI: 10.1111/pace.12009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Liu Z, Zhou C, Liu Y, Wang S, Ye P, Miao X, Xia J. The expression levels of plasma micoRNAs in atrial fibrillation patients. PLoS One 2012; 7:e44906. [PMID: 23028671 PMCID: PMC3445571 DOI: 10.1371/journal.pone.0044906] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2012] [Accepted: 08/09/2012] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND MicroRNA (miRNA) has been found in human blood. It has been increasingly suggested that miRNAs may serve as biomarkers for diseases. We examined the potential of circulating miRNA to serve as predictors of atrial fibrillation (AF). METHODOLOGY/PRINCIPAL FINDINGS During the discovery stage of this project, we used massively parallel signature sequencing (MPSS) to carry out an in-depth analysis of the miRNA expression profile (miRNome) in 5 healthy controls, 5 patients with paroxysmal atrial fibrillation (PAF) alone, and 5 patients with persistent atrial fibrillation (PersAF) alone. Twenty-two specific miRNAs were found to be dysregulated in each PAF group, PersAF group, or control group. Four candidate microRNAs (miRNA-146a, miRNA-150, miRNA-19a, and miRNA-375) met our selection criteria and were evaluated in an independent cohort of 90 plasma samples using TaqMan miRNA quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR). We found miRNA-150 levels to be reduced by a factor of approximately 17 in PAF relative to controls and a factor of approximately 20 in PersAF relative to controls (P<.0001). Logistic regression analyses were carried out to evaluate the reduced miRNA-150 expression levels (odds ratio [OR] 1.96, 95% confidence interval [CI] 1.5 to 3.57, P<0.001), age (OR 1.1, 95% CI 1.36 to 2.73, P<0.001), and Left atrial diameter (LAD) (OR 1.5, 95% CI 1.36 to 1.8, P<0.001). Each was independently associated with AF. Much of the identified target genes related to AF were part of the inflammatory response system. We found that plasma levels of CRP were negatively correlated with the plasma levels of miRNA-150. CONCLUSIONS/SIGNIFICANCE In summary, we firstly found that plasma miRNA-150 levels in from AF patients were substantially lower than that from healthy people. Circulating reduced miRNA-150 was significantly associated with AF.
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Affiliation(s)
- Zheng Liu
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Cheng Zhou
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yuzhou Liu
- Department of Cardiovascular Disease, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sihua Wang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ping Ye
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoping Miao
- Department of Epidemiology and Biostatistics and MOE Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiahong Xia
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Abstract
Mitral isthmus ablation forms part of the electrophysiologist’s armoury in the catheter ablation treatment of atrial fibrillation. It is well recognised however, that mitral isthmus ablation is technically challenging and incomplete ablation may be pro-arrhythmic, leading some to question its role. This article first reviews the evidence for the use of adjunctive mitral isthmus ablation and its association with the development of macroreentrant perimitral flutter. It then describes the practical techniques of mitral isthmus ablation, with particular emphasis on the assessment of bi-directional mitral isthmus block. The anatomy of the mitral isthmus is also discussed in order to understand the possible obstacles to successful ablation. Finally, novel techniques which may facilitate mitral isthmus ablation are reviewed.
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Affiliation(s)
- Kelvin Ck Wong
- Oxford Heart Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
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2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. J Interv Card Electrophysiol 2012; 33:171-257. [PMID: 22382715 DOI: 10.1007/s10840-012-9672-7] [Citation(s) in RCA: 256] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
This is a report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation, developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology and the European Cardiac Arrhythmia Society (ECAS), and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). This is endorsed by the governing bodies of the ACC Foundation, the AHA, the ECAS, the EHRA, the STS, the APHRS, and the HRS.
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Fragakis N, Pantos I, Younis J, Hadjipavlou M, Katritsis DG. Surgical ablation for atrial fibrillation. Europace 2012; 14:1545-52. [DOI: 10.1093/europace/eus081] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Calkins H, Kuck KH, Cappato R, Brugada J, Camm AJ, Chen SA, Crijns HJG, Damiano RJ, Davies DW, DiMarco J, Edgerton J, Ellenbogen K, Ezekowitz MD, Haines DE, Haissaguerre M, Hindricks G, Iesaka Y, Jackman W, Jalife J, Jais P, Kalman J, Keane D, Kim YH, Kirchhof P, Klein G, Kottkamp H, Kumagai K, Lindsay BD, Mansour M, Marchlinski FE, McCarthy PM, Mont JL, Morady F, Nademanee K, Nakagawa H, Natale A, Nattel S, Packer DL, Pappone C, Prystowsky E, Raviele A, Reddy V, Ruskin JN, Shemin RJ, Tsao HM, Wilber D. 2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Europace 2012; 14:528-606. [PMID: 22389422 DOI: 10.1093/europace/eus027] [Citation(s) in RCA: 1144] [Impact Index Per Article: 95.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Calkins H, Kuck KH, Cappato R, Brugada J, Camm AJ, Chen SA, Crijns HJG, Damiano RJ, Davies DW, DiMarco J, Edgerton J, Ellenbogen K, Ezekowitz MD, Haines DE, Haissaguerre M, Hindricks G, Iesaka Y, Jackman W, Jalife J, Jais P, Kalman J, Keane D, Kim YH, Kirchhof P, Klein G, Kottkamp H, Kumagai K, Lindsay BD, Mansour M, Marchlinski FE, McCarthy PM, Mont JL, Morady F, Nademanee K, Nakagawa H, Natale A, Nattel S, Packer DL, Pappone C, Prystowsky E, Raviele A, Reddy V, Ruskin JN, Shemin RJ, Tsao HM, Wilber D. 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design: a report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation. Developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology (ESC) and the European Cardiac Arrhythmia Society (ECAS); and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). Endorsed by the governing bodies of the American College of Cardiology Foundation, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, the Asia Pacific Heart Rhythm Society, and the Heart Rhythm Society. Heart Rhythm 2012; 9:632-696.e21. [PMID: 22386883 DOI: 10.1016/j.hrthm.2011.12.016] [Citation(s) in RCA: 1304] [Impact Index Per Article: 108.7] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Indexed: 12/20/2022]
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Anselmino M, D’Ascenzo F, Amoroso G, Ferraris F, Gaita F. History of transcatheter atrial fibrillation ablation. J Cardiovasc Med (Hagerstown) 2012; 13:1-8. [PMID: 22130041 DOI: 10.2459/jcm.0b013e32834ead59] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Schuessler RB, Lee AM, Melby SJ, Voeller RK, Gaynor SL, Sakamoto SI, Damiano RJ. Animal studies of epicardial atrial ablation. Heart Rhythm 2011; 6:S41-5. [PMID: 19959142 DOI: 10.1016/j.hrthm.2009.07.028] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Indexed: 11/25/2022]
Abstract
The Cox maze procedure is an effective treatment of atrial fibrillation, with a long-term freedom from recurrence greater than 90%. The original procedure was highly invasive and required cardiopulmonary bypass. Modifications of the procedure that eliminate the need for cardiopulmonary bypass have been proposed, including use of alternative energy sources to replace cut-and-sew lesions with lines of ablation made from the epicardium on the beating heart. This has been challenging because atrial wall muscle thickness is extremely variable, and the muscle can be covered with an epicardial layer of fat. Moreover, the circulating intracavitary blood acts as a potential heat sink, making transmural lesions difficult to obtain. In this report, we summarize the use of nine different unidirectional devices (four radiofrequency, two microwave, two lasers, one cryothermic) for creating continuous transmural lines of ablation from the atrial epicardium in a porcine model. We define a unidirectional device as one in which all the energy is applied by a single transducer on a single heart surface. The maximum penetration of any device was 8.3 mm. All devices except one, the AtriCure Isolator pen, failed to penetrate 2 mm in some nontransmural sections. Future development of unidirectional energy sources should be directed at increasing the maximum depth and the consistency of penetration.
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Affiliation(s)
- Richard B Schuessler
- Barnes Jewish Hospital and Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA.
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Abstract
Atrial fibrillation (AF) is the most prevalent sustained cardiac arrhythmia in adults, affecting >1% of general population. Atrial fibrillation is commonly associated with structural heart disease and is a major cause of significant cardiovascular morbidity and mortality. AF sometimes develops in a subset of young patients (e.g. aged ≤60 years), with no evidence of associated cardiopulmonary or other comorbid disease (including hypertension), and has been referred to as 'lone AF'. The latter generally has a favourable prognosis; the prognostic and therapeutic implications of an accurate identification of patients with truly lone AF (that is, truly at low risk of complications), if any, would be of the utmost importance. The true prevalence of lone AF is unknown, varying between 1.6% and 30%, depending on the particular study population. Nonetheless, novel risk factors for AF, including obesity, metabolic syndrome, sleep apnea, alcohol consumption, endurance sports, anger, hostility, subclinical atherosclerosis and others, have been increasingly recognised. Also, various underlying pathophysiological mechanisms predisposing to AF, including increased atrial stretch, structural and electrophysiological alterations, autonomic imbalance, systemic inflammation, oxidative stress and genetic predisposition, have been proposed. The growing evidence of these diverse (and numerous) pathogenic mechanisms and factors related to AF inevitably raises the question of whether 'lone AF' does exist at all. In this review article, we summarise the current knowledge of the epidemiology, pathophysiology, clinical course and treatment of patients with so-called 'lone AF' and outline emerging insights into its pathogenesis and the potential therapeutic implications of a diagnosis of lone AF.
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Affiliation(s)
- T S Potpara
- University Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
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Gaita F, Leclercq JF, Schumacher B, Scaglione M, Toso E, Halimi F, Schade A, Froehner S, Ziegler V, Sergi D, Cesarani F, Blandino A. Incidence of Silent Cerebral Thromboembolic Lesions After Atrial Fibrillation Ablation May Change According to Technology Used: Comparison of Irrigated Radiofrequency, Multipolar Nonirrigated Catheter and Cryoballoon. J Cardiovasc Electrophysiol 2011; 22:961-8. [PMID: 21453372 DOI: 10.1111/j.1540-8167.2011.02050.x] [Citation(s) in RCA: 217] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Fiorenzo Gaita
- Cardiology Division, Department of Internal Medicine, San Giovanni Battista Hospital, University of Turin, Italy.
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Camm AJ, Kirchhof P, Lip GYH, Schotten U, Savelieva I, Ernst S, Van Gelder IC, Al-Attar N, Hindricks G, Prendergast B, Heidbuchel H, Alfieri O, Angelini A, Atar D, Colonna P, De Caterina R, De Sutter J, Goette A, Gorenek B, Heldal M, Hohloser SH, Kolh P, Le Heuzey JY, Ponikowski P, Rutten FH. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Europace 2011; 12:1360-420. [PMID: 20876603 DOI: 10.1093/europace/euq350] [Citation(s) in RCA: 1017] [Impact Index Per Article: 78.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Castellá M, Pereda D, Mestres CA, Gómez F, Quintana E, Mulet J. Thoracoscopic pulmonary vein isolation in patients with atrial fibrillation and failed percutaneous ablation. J Thorac Cardiovasc Surg 2010; 140:633-8. [DOI: 10.1016/j.jtcvs.2009.11.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Revised: 10/07/2009] [Accepted: 11/04/2009] [Indexed: 10/19/2022]
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Camm AJ, Kirchhof P, Lip GYH, Schotten U, Savelieva I, Ernst S, Van Gelder IC, Al-Attar N, Hindricks G, Prendergast B, Heidbuchel H, Alfieri O, Angelini A, Atar D, Colonna P, De Caterina R, De Sutter J, Goette A, Gorenek B, Heldal M, Hohloser SH, Kolh P, Le Heuzey JY, Ponikowski P, Rutten FH. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J 2010; 31:2369-429. [PMID: 20802247 DOI: 10.1093/eurheartj/ehq278] [Citation(s) in RCA: 3284] [Impact Index Per Article: 234.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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Montefusco A, Biasco L, Blandino A, Cristoforetti Y, Scaglione M, Caponi D, Di Donna P, Boffano C, Cesarani F, Coin D, Perversi J, Gaita F. Left atrial volume at MRI is the main determinant of outcome after pulmonary vein isolation plus linear lesion ablation for paroxysmal-persistent atrial fibrillation. J Cardiovasc Med (Hagerstown) 2010; 11:593-8. [DOI: 10.2459/jcm.0b013e32833831e4] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Houltz B, Johansson B, Berglin E, Karlsson T, Edvardsson N, Wandt B. Left Ventricular Diastolic Function and Right Atrial Size Are Important Rhythm Outcome Predictors after Intraoperative Ablation for Atrial Fibrillation. Echocardiography 2010; 27:961-8. [DOI: 10.1111/j.1540-8175.2010.01167.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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