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Myrda K, Buchta P, Błachut A, Skrzypek M, Gąsior M. Temporary Trends Concerning the Extent and Efficacy of Atrial Fibrillation Ablation Using Radiofrequency Energy in a Polish Single-Center Experience. Medicina (B Aires) 2022; 58:medicina58020187. [PMID: 35208512 PMCID: PMC8878639 DOI: 10.3390/medicina58020187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 01/18/2022] [Accepted: 01/21/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives: Atrial fibrillation (AF) is the most common supraventricular arrhythmia. Currently, catheter ablation is a preferred treatment strategy. The main objective of our study was a temporary trends analysis of patients’ data undergoing a single AF ablation procedure using radiofrequency energy (RF). The efficacy of the procedure underwent assessment during a 12-month follow-up. Materials and Methods: We analyzed 585 consecutive patients with symptomatic, recurrent, and drug-refractory AF hospitalized in our department between 2013 and 2018 who underwent RF ablation supported by a 3D electroanatomical system. The baseline characteristics, periprocedural parameters, and efficacy of the procedure at 6-, 9- and 12-month follow-ups were analyzed over the years. Results: The number of patients undergoing ablation increased. Patients with paroxysmal AF predominated (71.5%). However, the number of patients with the persistent type of arrhythmia increased over the years. The percentage of patients with chronic heart failure (CHF) increased to 27.5% in 2018, and patients presented with increasingly larger left atria (LA). In all patients, circumferential pulmonary vein isolation was performed. The percentage of patients who underwent arrhythmogenic substrate modification and cavotricuspid isthmus ablation increased. Over the years, the efficacy of a single procedure at the 12-month follow-up remained without significant differences between the years (72.0%, 69.6%, 75.5%, 74.8%, 71.7%, 71.7%). Conclusions: The rate of patients with CHF and advanced LA disease undergoing more extensive ablation increased over the years. The efficacy of a single procedure remained without significant differences between the years.
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Affiliation(s)
- Krzysztof Myrda
- 3rd Department of Cardiology, Silesian Center for Heart Diseases, 41-800 Zabrze, Poland; (A.B.); (M.G.)
- Correspondence: ; Tel.: +48-506-603-277
| | - Piotr Buchta
- Silesian Center for Heart Diseases, 41-800 Zabrze, Poland;
| | - Aleksandra Błachut
- 3rd Department of Cardiology, Silesian Center for Heart Diseases, 41-800 Zabrze, Poland; (A.B.); (M.G.)
| | - Michał Skrzypek
- Department of Biostatistics, School of Health Sciences in Bytom, Medical University of Silesia, 40-055 Katowice, Poland;
| | - Mariusz Gąsior
- 3rd Department of Cardiology, Silesian Center for Heart Diseases, 41-800 Zabrze, Poland; (A.B.); (M.G.)
- 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland
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Zheng Z, Li H, Liu S, Gao G, Yu C, Lin H, Meng Y. Box lesion or bi-atrial lesion set for atrial fibrillation during thoracoscopic epicardial ablation. Interact Cardiovasc Thorac Surg 2022; 34:1-8. [PMID: 34999802 PMCID: PMC8923398 DOI: 10.1093/icvts/ivab211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/27/2021] [Accepted: 07/07/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Thoracoscopic epicardial ablation with a limited lesion set led to suboptimal results for advanced paroxysmal atrial fibrillation (AF) or persistent AF. Whether additional right atrial lesions improve the result is unclear. METHODS We conducted a retrospective study involving 80 consecutive patients with paroxysmal or persistent AF, left atrial (LA) dilation (LA diameter >40 mm) and failed prior interventional ablation (40 patients, 50%) who underwent thoracoscopic epicardial ablation with box lesions (36 patients) or bi-atrial (BA) lesion (44 patients) in our institution. Freedom from atrial tachyarrhythmias after the procedures was compared between the box lesion group and BA lesion group. RESULTS Baseline differences included more patients with persistent AF (86.4% vs 47.2%) and larger left atrium [48.00 (44.00-50.75) vs 42.00 (41.25-44.00) mm] in the BA lesion group. There was no difference in procedural complications between the 2 groups. After a mean follow-up of 32 months, the freedom from atrial tachyarrhythmias off antiarrhythmic drugs at 6, 12 and 24 months was 77.2%, 77.2% and 77.2% in the BA lesion group and 69.4%, 50.0% and 40.6% in the box lesion group, respectively (P = 0.006). After adjustment for sex, age, body mass index, LA diameter, AF type, history of AF, and previous interventional ablation, BA lesion was an independent predictor of lower atrial tachyarrhythmia recurrence (hazard ratio 0.447, 95% confidential interval 0.208-0.963; P = 0.040). CONCLUSIONS Compared with the box lesion set, thoracoscopic epicardial ablation with BA lesion sets might provide better freedom from atrial tachyarrhythmias for paroxysmal or persistent AF with LA dilation. Randomized control trials are warranted to confirm the benefit of BA lesion sets in these patients.
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Affiliation(s)
- Zhe Zheng
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haojie Li
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sheng Liu
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ge Gao
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chunyu Yu
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hengqiang Lin
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Meng
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Kim HR, Jeong DS, Kwon HJ, Park SJ, Park KM, Kim JS, On YK. Total thoracoscopic ablation in patients with atrial fibrillation and left ventricular dysfunction. JTCVS Tech 2021; 8:60-66. [PMID: 34401814 PMCID: PMC8350785 DOI: 10.1016/j.xjtc.2021.04.006] [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: 04/02/2021] [Accepted: 04/07/2021] [Indexed: 01/22/2023] Open
Abstract
Objective To evaluate the effectiveness and safety of totally thoracoscopic ablation (TTA) in patients with left ventricular (LV) dysfunction for treatment of atrial fibrillation (AF) refractory to antiarrhythmic drug (AAD) therapy. Methods Between January 2012 and December 2018, 31 patients underwent TTA with drug-refractory AF and preoperative left ventricular ejection fraction (LVEF) <50% were included. Of the 31 patients, 8 received additional catheter ablation with an electrophysiologic study within 3 months after TTA. The rhythm outcome was obtained by 12-lead electrocardiography or 24-hour Holter monitoring. Results The patient cohort had a mean age of 54.9 ± 9.0 years and consisted of 51.6% with persistent AF (n = 16), 45.2% with long-standing persistent AF (n = 14), and 3.2% with paroxysmal AF (n = 1). No patients died during the follow-up period. Compared with baseline, mean postoperative LVEF at 3 months (interquartile range [IQR], 2-6 months) increased significantly (from 39.7 ± 6.1% to 53.6 ± 9.3%; P < .001). At 25 months (IQR, 14-45 months), LVEF was sustained or further improved (from 39.7 ± 6.1% to 58.1 ± 7.5%; P < .001). The rate of sinus rhythm state was 93.5% (29 of 31), and freedom from arrhythmias off AADs after the final procedure was 61.3% (19 of 31) at a median follow-up of 32 months (IQR, 24-54 months). Conclusions TTA is a safe and effective procedure that improves LV function and restores sinus rhythm in AF patients with LV dysfunction.
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Key Words
- AAD, antiarrhythmic drug
- AF, atrial fibrillation
- ECG, electrocardiography
- GP, ganglionated plexus
- HF, heart failure
- IQR, interquartile range
- LA, left atrium/atrial
- LV, left ventricle/ventricular
- LVEF, left ventricular ejection fraction
- PV, pulmonary vein
- TTA, totally thoracoscopic ablation
- atrial fibrillation
- catheter ablation
- heart failure
- left ventricular dysfunction
- surgical ablation
- totally thoracoscopic ablation
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Affiliation(s)
- Hye Ree Kim
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Heart, Vascular and Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong-Seop Jeong
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Hee-Jin Kwon
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Heart, Vascular and Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung-Jung Park
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Heart, Vascular and Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyoung-Min Park
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Heart, Vascular and Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - June Soo Kim
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Heart, Vascular and Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Keun On
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Heart, Vascular and Stroke Institute, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Vachev SA, Bogachev-Prokof'ev AV, Zotov AS, Elesin DA, Voronin SV, Troitskiĭ AV, Khabazov RI. Surgical treatment of atrial fibrillation: technique of thoracoscopic radiofrequency fragmentation of the left atrium. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2019; 25:146-157. [PMID: 31855212 DOI: 10.33529/angio2019416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Presented in the article is a detailed description of a modified technique of minimally invasive surgical treatment of patients with atrial fibrillation - thoracoscopic radiofrequency fragmentation of the left atrium. This modification differs from the prototype GALAXY procedure by a significant increase of the 'quantitative' rather than 'qualitative' parameter of surgical aggression in relation to the left atrium. This technique results in creation of multiple transmural continuous closed lines of lesion to the left atrium and, consequently, a reduced risk of inadequate surgical treatment for atrial fibrillation. Besides the radiofrequency action on the wall of the left atrium, the protocol of the operation included destruction of the ligament of Marshall and resection of the left atrial appendage. An indication for performing this operation is the presence of various forms of atrial fibrillation.
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Affiliation(s)
- S A Vachev
- Federal Scientific and Clinical Centre of Specialized Medical Care and Medical Technologies, Federal Biomedical Agency, Moscow, Russia
| | - A V Bogachev-Prokof'ev
- National Medical Research Centre named after Academician E.N. Meshalkin under the RF Ministry of Public Health, Novosibirsk, Russia
| | - A S Zotov
- Federal Scientific and Clinical Centre of Specialized Medical Care and Medical Technologies, Federal Biomedical Agency, Moscow, Russia
| | - D A Elesin
- National Medical Research Centre named after Academician E.N. Meshalkin under the RF Ministry of Public Health, Novosibirsk, Russia
| | - S V Voronin
- Federal Scientific and Clinical Centre of Specialized Medical Care and Medical Technologies, Federal Biomedical Agency, Moscow, Russia
| | - A V Troitskiĭ
- Federal Scientific and Clinical Centre of Specialized Medical Care and Medical Technologies, Federal Biomedical Agency, Moscow, Russia
| | - R I Khabazov
- Federal Scientific and Clinical Centre of Specialized Medical Care and Medical Technologies, Federal Biomedical Agency, Moscow, Russia
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Vos LM, Bentala M, Geuzebroek GSC, Molhoek SG, Putte BP. Long‐term outcome after totally thoracoscopic ablation for atrial fibrillation. J Cardiovasc Electrophysiol 2019; 31:40-45. [DOI: 10.1111/jce.14267] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Revised: 09/21/2019] [Accepted: 09/27/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Lara M. Vos
- Department of Cardiothoracic SurgerySt. Antonius Hospital Nieuwegein The Netherlands
- Department of Cardiothoracic SurgeryAmsterdam University Medical Centers Amsterdam The Netherlands
| | - Mohamed Bentala
- Department of Cardiothoracic SurgeryAmphia Hospital Breda The Netherlands
| | | | | | - Bart P. Putte
- Department of Cardiothoracic SurgerySt. Antonius Hospital Nieuwegein The Netherlands
- Department of Cardiothoracic SurgeryAmsterdam University Medical Centers Amsterdam The Netherlands
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Sun Z, Fu P, Odo N, Patel V, Sharma G, Agarwal S. Anesthetic Management of Total Thoracoscopic Left Atrial Maze Procedure for Chronic Atrial Fibrillation-A Single-Institution Experience. J Cardiothorac Vasc Anesth 2019; 33:1801-1808. [PMID: 30928286 DOI: 10.1053/j.jvca.2019.02.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 02/15/2019] [Accepted: 02/16/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Zhuo Sun
- Department of Anesthesiology and Perioperative Medicine, Division of Cardiovascular Anesthesia, Medical College of Georgia at Augusta University, Augusta, GA
| | - Ping Fu
- Department of Anesthesiology and Perioperative Medicine, Division of Cardiovascular Anesthesia, Medical College of Georgia at Augusta University, Augusta, GA
| | - Nadine Odo
- Department of Anesthesiology and Perioperative Medicine, Division of Cardiovascular Anesthesia, Medical College of Georgia at Augusta University, Augusta, GA
| | - Vijay Patel
- Department of Surgery, Division of Cardiovascular Surgery, Medical College of Georgia at Augusta University, Augusta, GA
| | - Gyanendra Sharma
- Department of Medicine, Division of Cardiology, Medical College of Georgia at Augusta University, Augusta, GA
| | - Shvetank Agarwal
- Department of Anesthesiology and Perioperative Medicine, Division of Cardiovascular Anesthesia, Medical College of Georgia at Augusta University, Augusta, GA.
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Boulad N, Shammas NW, Early G, Roberts S, Shammas GA, Hu YL, Park H, Jerin M. Ten-year outcome of intraoperative treatment of atrial fibrillation using radiofrequency ablation. Ther Clin Risk Manag 2017; 13:1233-1237. [PMID: 29033573 PMCID: PMC5614737 DOI: 10.2147/tcrm.s136173] [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] [Indexed: 11/23/2022] Open
Abstract
Background Intraoperative radiofrequency ablation (RFA) has been advocated to treat atrial fibrillation (AF). This report examines the long-term effects of intraoperative RFA in the prevention of recurrence of AF when used as an adjunctive treatment in patients undergoing cardiac procedures for primary indications unrelated to their arrhythmia. Methods The study reviewed the records of patients from a tertiary medical center which had 2 cardiac surgeons performing an intraoperative adjunctive RFA procedure. A total of 20 patients undergoing RFA between April 11, 2003 and May 10, 2005 were included and followed for up to 10 years. The primary effectiveness outcome of the study was the recurrence of AF during the follow-up period. Data were collected from office or hospital medical records. Results A total of 20 patients were included (mean age 69.4 years, males 40%). Eight patients were followed for 10 years and 2 patients for 9 years; 7 patients died during the 10-year follow-up period and 3 patients were lost to follow-up. As their primary procedures, the patients underwent valve surgery (65%), bypass surgery (15%), or both (20%). Intraoperative RFA failed to restore sinus rhythm in 2 patients. In the remaining 18 patients, AF recurred in 10 patients within 2 months of surgery, in 1 patient at 5 months, in 1 patient at 7 months, and in 6 patients after 1 year. Conclusion AF had recurred in 100% of patients by the end of the long-term follow-up period. The adjunctive intraoperative RFA and postoperative interventions employed in this early study failed to maintain sinus rhythm.
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Affiliation(s)
- Nour Boulad
- Midwest Cardiovascular Research Foundation, Bettendorf, IA
| | | | - Gerald Early
- Cardiac and Thoracic Surgery, Pullman Hospital, Pullman, WA
| | - Shauna Roberts
- Truman Medical Center-Hospital Hill, Kansas City, MO, USA
| | - Gail A Shammas
- Midwest Cardiovascular Research Foundation, Bettendorf, IA
| | | | - Holly Park
- Midwest Cardiovascular Research Foundation, Bettendorf, IA
| | - Michael Jerin
- Midwest Cardiovascular Research Foundation, Bettendorf, IA
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Budera P, Osmančík P, Talavera D, Kraupnerová A, Rizov V, Fojt R, Straka Z. Thoracoscopic ablation of atrial fibrillation - Should we still be concerned about periprocedural complications? COR ET VASA 2017. [DOI: 10.1016/j.crvasa.2017.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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