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Kim J, Bak M, Park SJ, Jeong DS, Chung S, Kim D, Kim EK, Chang SA, Choi JO, Lee SC, Park SW. Clinical Implication of Left Atrial Appendage Emptying Velocity in Thoracoscopic Ablation of Atrial Fibrillation. Circ J 2023; 87:1742-1749. [PMID: 37380436 DOI: 10.1253/circj.cj-23-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
BACKGROUND There are limited data about predictors of atrial fibrillation (AF) recurrence after totally thoracoscopic ablation (TTA). This study investigated the clinical implication of left atrial appendage emptying velocity (LAAV) in patients undergoing TTA.Methods and Results: Patients who underwent TTA between 2012 and 2015 at a tertiary hospital were prospectively enrolled in this study. LAAV was measured and averaged over five heart beats from preoperative transesophageal echocardiography. The primary outcome was a freedom from recurrent AF or atrial flutter (AFL) detected on 24-h Holter monitoring or an electrocardiogram over a 3-year period after TTA. In all, 129 patients were eligible for analysis in this study. The mean (±SD) patient age was 54.4±8.8 years, and 95.3% were male. During the 3 years after TTA, the overall event-free survival rate was 65.3%. LAAV was an independent predictor of recurrent AF/AFL during the 3-year period after TTA (per 1-cm/s increase, adjusted hazard ratio [aHR] 0.95; 95% confidence interval [CI] 0.91-0.99; P=0.016). Event-free survival was significantly lower among patients with a low LAAV (<20 cm/s; n=21) compared with those with a normal (≥40 cm/s; n=38; aHR 6.11; 95% CI 1.42-26.15; P=0.015) or intermediate (LAAV ≥20 and <40 cm/s; n=70; aHR 2.74, 95% CI 1.29-5.83; P=0.009) LAAV. CONCLUSIONS In patients with AF, LAAV was significantly associated with the risk of long-term recurrence of AF after TTA.
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Affiliation(s)
- Jihoon Kim
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Minjung Bak
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Sung-Ji Park
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Dong Seop Jeong
- Department of Thoracic and Cardiovascular Surgery, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Suryeun Chung
- Department of Thoracic and Cardiovascular Surgery, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Darae Kim
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Eun Kyoung Kim
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Sung-A Chang
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Jin-Oh Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Sang-Chol Lee
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
| | - Seung Woo Park
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine
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2
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Pannone L, Mouram S, Della Rocca DG, Sorgente A, Monaco C, Del Monte A, Gauthey A, Bisignani A, Kronenberger R, Paparella G, Ramak R, Overeinder I, Bala G, Almorad A, Ströker E, Sieira J, Brugada P, Chierchia GB, La Meir M, de Asmundis C. Hybrid atrial fibrillation ablation: long-term outcomes from a single-centre 10-year experience. Europace 2023; 25:euad114. [PMID: 37246904 PMCID: PMC10226374 DOI: 10.1093/europace/euad114] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 04/04/2023] [Indexed: 05/30/2023] Open
Abstract
AIMS Hybrid atrial fibrillation (AF) ablation is a promising approach in non-paroxysmal AF. The aim of this study is to assess the long-term outcomes of hybrid ablation in a large cohort of patients after both an initial and as a redo procedure. METHODS AND RESULTS All consecutive patients undergoing hybrid AF ablation at UZ Brussel from 2010 to 2020 were retrospectively evaluated. Hybrid AF ablation was performed in a one-step procedure: (i) thoracoscopic ablation followed by (ii) endocardial mapping and eventual ablation. All patients received PVI and posterior wall isolation. Additional lesions were performed based on clinical indication and physician judgement. Primary endpoint was freedom from atrial tachyarrhythmias (ATas). A total of 120 consecutive patients were included, 85 patients (70.8%) underwent hybrid AF ablation as first procedure (non-paroxysmal AF 100%), 20 patients (16.7%) as second procedure (non-paroxysmal AF 30%), and 15 patients (12.5%) as third procedure (non-paroxysmal AF 33.3%). After a mean follow-up of 62.3 months ± 20.3, a total of 63 patients (52.5%) experienced ATas recurrence. Complications occurred in 12.5% of patients. There was no difference in ATas between patients undergoing hybrid as first vs. redo procedure (P = 0.53). Left atrial volume index and recurrence during blanking period were independent predictors of ATas recurrence. CONCLUSION In a large cohort of patients undergoing hybrid AF ablation, the survival from ATas recurrence was 47.5% at ≈5 years follow-up. There was no difference in clinical outcomes between patients undergoing hybrid AF ablation as first procedure or as a redo.
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Affiliation(s)
- Luigi Pannone
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Sahar Mouram
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Domenico Giovanni Della Rocca
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Antonio Sorgente
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Cinzia Monaco
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Alvise Del Monte
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Anaïs Gauthey
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Antonio Bisignani
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
- Arrhythmology Unit, Ospedale Fatebenefratelli Isola Tiberina-Gemelli Isola, Rome, Italy
| | - Rani Kronenberger
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, Brussels, Belgium
| | - Gaetano Paparella
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Robbert Ramak
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Ingrid Overeinder
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Gezim Bala
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Alexandre Almorad
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Erwin Ströker
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Juan Sieira
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Pedro Brugada
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Gian Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Mark La Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, Brussels, Belgium
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel—Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Laarbeeklaan 101, 1090 Brussels, Belgium
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3
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van der Heijden CAJ, Segers P, Masud A, Weberndörfer V, Chaldoupi SM, Luermans JGLM, Bijvoet GP, Kietselaer BLJH, van Kuijk SMJ, Barenbrug PJC, Maessen JG, Bidar E, Maesen B. Unilateral Left-sided Thoracoscopic Ablation of Atrial Fibrillation Concomitant to Minimally Invasive Bypass Grafting of the Left Anterior Descending Artery. Eur J Cardiothorac Surg 2022; 62:6659858. [PMID: 35947693 PMCID: PMC9531601 DOI: 10.1093/ejcts/ezac409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/26/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Thoracoscopic ablation for atrial fibrillation (AF) and minimally invasive direct coronary artery bypass (MIDCAB) with robot-assisted left internal mammary artery (LIMA) harvesting may represent a safe and effective alternative to more invasive surgical approaches via sternotomy. The aim of our study was to describe the feasibility, safety and efficacy of a unilateral left-sided thoracoscopic AF ablation and concomitant MIDCAB surgery. METHODS Retrospective analysis of a prospectively gathered cohort was performed of all consecutive patients with AF and at least a critical left anterior descending artery (LAD) stenosis that underwent unilateral left-sided thoracoscopic AF ablation and concomitant off-pump MIDCAB surgery in the Maastricht University Medical Centre between 2017 and 2021. RESULTS Twenty-three patients were included (age 69 years (standard deviation = 8), paroxysmal AF 61%, left atrial volume index 42 ml/m2 (standard deviation = 11)). Unilateral left-sided thoracoscopic isolation of the left (n = 23) and right (n = 22) pulmonary veins and box (n = 21) by radiofrequency ablation was succeeded by epicardial validation of exit- and entrance block (n = 22). All patients received robot-assisted LIMA harvesting and off-pump LIMA-LAD anastomosis through a left mini-thoracotomy. Perioperative complications consisted of one bleeding of the thoracotomy wound and one aborted myocardial infarction not requiring intervention. Mean duration of hospital stay was 6 days (standard deviation = 2). After discharge, cardiac hospital readmission occurred in four patients (AF n = 1; pleural- and pericardial effusion n = 2, myocardial infarction requiring percutaneous intervention of the LIMA-LAD n = 1) within one year. After 12 months, 17/21 (81%) patients were in sinus rhythm when allowing anti-arrhythmic drugs. Finally, the left atrial ejection fraction improved postoperatively (26% (standard deviation = 11) to 38% (standard deviation = 7), P = 0.01). CONCLUSIONS In this initial feasibility and early safety study, unilateral left-sided thoracoscopic AF ablation and concomitant MIDCAB for LIMA-LAD grafting is a feasible, safe and efficacious for patients with AF and a critical LAD stenosis.
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Affiliation(s)
- Claudia A J van der Heijden
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht,Maastricht University, Maastricht, Netherlands
| | - Patrique Segers
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Anna Masud
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Vanessa Weberndörfer
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Sevasti-Marisevi Chaldoupi
- Cardiovascular Research Institute Maastricht,Maastricht University, Maastricht, Netherlands.,Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Justin G L M Luermans
- Cardiovascular Research Institute Maastricht,Maastricht University, Maastricht, Netherlands.,Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Geertruida P Bijvoet
- Cardiovascular Research Institute Maastricht,Maastricht University, Maastricht, Netherlands.,Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Bas L J H Kietselaer
- Cardiovascular Research Institute Maastricht,Maastricht University, Maastricht, Netherlands.,Department of Cardiology, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, the Netherlands
| | - Paul J C Barenbrug
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht,Maastricht University, Maastricht, Netherlands
| | - Elham Bidar
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht,Maastricht University, Maastricht, Netherlands
| | - Bart Maesen
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht,Maastricht University, Maastricht, Netherlands
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4
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Vos LM, Fleerakkers J, Hofman FN, van Putte BP. Closed chest unilateral thoracoscopic ablation: box lesion with radiofrequency clamps only. Eur J Cardiothorac Surg 2022; 62:6594493. [PMID: 35640115 DOI: 10.1093/ejcts/ezac316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/12/2022] [Accepted: 05/24/2022] [Indexed: 11/12/2022] Open
Abstract
In this article we describe the modified technique of a unilateral closed chest thoracoscopic ablation and left atrial appendage closure including a box lesion that is made by radiofrequency clamps only for the treatment of atrial fibrillation. By abandoning the unidirectional pen devices and replacing these by radiofrequency clamps, we aim to further improve the procedural efficacy and shorten operation time while minimizing surgical exposure for the patient.
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Affiliation(s)
- Lara M Vos
- Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, Netherlands.,Department of Cardiothoracic Surgery, Amsterdam UMC, Amsterdam, Netherlands
| | - Jelle Fleerakkers
- Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, Netherlands
| | - Frederik N Hofman
- Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, Netherlands
| | - Bart P van Putte
- Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, Netherlands.,Department of Cardiothoracic Surgery, Amsterdam UMC, Amsterdam, Netherlands
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5
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Lee Y, Jeong DS, Ahn J, Park KM, Park SJ, Kim JS, On YK. New Oral Anticoagulant Versus Vitamin K Antagonists for Thoracoscopic Ablation in Patients With Persistent Atrial Fibrillation: A Randomized Controlled Trial. Semin Thorac Cardiovasc Surg 2021; 35:268-274. [PMID: 34879226 DOI: 10.1053/j.semtcvs.2021.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 12/02/2021] [Indexed: 01/10/2023]
Abstract
Anticoagulation could not be currently stopped even after successful thoracoscopic ablation of atrial fibrillation for at least 2 months. The aim of this study is to compare the safety and efficacy outcomes between a new oral anticoagulant and warfarin after thoracoscopic ablation. This trial was a single-center, prospective, randomized controlled study comparing edoxaban and warfarin in patients undergoing thoracoscopic ablation of atrial fibrillation. This study enrolled 60 patients randomly assigned into 2 groups. The primary endpoint was efficacy outcomes, including stroke and systemic thromboembolic events. The secondary endpoint was safety outcomes including major bleeding and pericarditis. The patients were evaluated at discharge, 2 weeks, 3 months, and 6 months postoperatively. No stroke and thromboembolic events were noted in both treatment groups during the follow-up period. During the 6 months follow-up period, 4 (13%) of 30 patients in the edoxaban group experienced minor bleeding events, whereas none were noted in the warfarin group. Five anticoagulation-related events (bleeding, and prolongation of international normalized ratio), including pericarditis, were noted in both the edoxaban and warfarin groups. No statistically significant difference existed between the 2 groups. In conclusion, this study showed the comparable results of edoxaban to warfarin during the window period of post-thoracoscopic ablation of atrial fibrillation. Moreover, anticoagulation-related events were rather affected by patient factors and not by the anticoagulant type.
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Affiliation(s)
- Yoonseo Lee
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, 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.
| | - Joonghyun Ahn
- Biostatistics and Clinical Epidemiology Center, Samsung Medical Center, Seoul, Republic of Korea
| | - Kyoung-Min Park
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung-Jung Park
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - June Soo Kim
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Keun On
- Division of Cardiology, Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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6
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Maesen B, Bidar E, Luermans JG, Maessen JG. Ablation of persistent atrial fibrillation: the added value of hybrid. Eur J Cardiothorac Surg 2021; 60:231-232. [PMID: 33842938 PMCID: PMC8327200 DOI: 10.1093/ejcts/ezab170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Bart Maesen
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands.,Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Elham Bidar
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands.,Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Justin Glm Luermans
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands.,Department of Cardiology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands.,Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
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7
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Kwon HJ, Jeong DS, Park SJ, Park KM, Kim JS, On YK. Long-term outcome of totally thoracoscopic surgical ablation in atrial fibrillation: A single-center experience. Int J Cardiol Heart Vasc 2021; 36:100861. [PMID: 34485680 PMCID: PMC8399062 DOI: 10.1016/j.ijcha.2021.100861] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 08/13/2021] [Accepted: 08/16/2021] [Indexed: 10/28/2022]
Abstract
Background Totally thoracoscopic ablation (TTA) is a minimally invasive and safe alternative to radiofrequency catheter ablation (RFCA) for patients with atrial fibrillation (AF). It has evolved over the last decades, but data are limited. The aim of this study was to report the long-term efficacy and safety of TTA through a single center experience. Methods We retrospectively analyzed all consecutive patients who underwent TTA for AF from February 2012 to December 2018. All patients were followed every 3 months after operation with 12-lead ECG and 24-hour Holter ECG monitoring. The late recurrence of AF was defined as any atrial tachyarrhythmia (ATa) sustained more than 30 s from 3 months after surgery. Results Of the total 408 patients undergoing TTA, 265 were analyzed in this study (17% paroxysmal, persistent or long standing persistent 83%, mean age 56 ± 9 years). During the mean follow-up duration 23 ± 18 months, ATa-free survival rate was 74%, 64%, 58%, 51% and 51% at 1,2,3,4 and 5 years, respectively. At the last follow-up, 75% of patients had sinus rhythm with or without additional intervention. The overall complication rate was 4.5% (12 events) and four patients (1.5%) had a stroke during follow-up. Conclusions TTA could be effective treatment option for AF. It had a very low risk of complication and could reduce stroke incidence. Further studies are needed to improve treatment strategy.
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Affiliation(s)
- Hee-Jin Kwon
- Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Dong Seop Jeong
- Department of Thoracic and Cardiovascular Surgery, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung-Jung Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyoung-Min Park
- Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - June Soo Kim
- Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Keun On
- Division of Cardiology, Department of Internal Medicine, Heart Vascular and Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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8
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Maesen B, Luermans JGLM, Bidar E, Chaldoupi SM, Gelsomino S, Maessen JG, Pison L, Meir ML. A hybrid approach to complex arrhythmias. Europace 2021; 23:ii28-ii33. [PMID: 33837755 DOI: 10.1093/europace/euab027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 01/20/2021] [Indexed: 12/16/2022] Open
Abstract
Despite many years of research, the different aspects of the mechanism of atrial fibrillation (AF) are still incompletely understood. And although the latest guidelines recommend catheter ablation with pulmonary vein isolation as a rhythm control strategy, long-term results in persistent and long-standing persistent AF are suboptimal. Historically, a mechanistic-based patient-tailored approach for the treatment of AF was impossible because of the lack real-time mapping techniques and advanced ablation tools. Therefore, surgeons created lesion sets based upon the anatomy of both atria and the safety of the incisions made by the knife. These complex open-heart procedures had to be performed through a sternotomy on the arrested heart and where therefore not generally adopted. The use of controlled energy sources such as cryothermy and radiofrequency where the first step to make the creation of these lesions less complex. With the development and improvement of electrophysiology techniques and catheters, this invasive and solely anatomical approach could again be partially redesigned. Now less invasive, it prepared the way for collaboration between electrophysiologists working on the endocardial side of the heart and cardiac surgeons providing epicardial access. The introduction of video-assisted technology and hybrid procedures has further increased the possibilities of new successful therapies. Now more than 40 years since the beginning of this exciting maze of AF procedures and still working towards a less aggressive and more comprehensive approach we give an overview of the history of the different minimally invasive surgical solutions and of the hybrid approach.
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Affiliation(s)
- Bart Maesen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.,Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Justin G L M Luermans
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands.,Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Elham Bidar
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.,Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | - Sevasti-Maria Chaldoupi
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands.,Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Sandro Gelsomino
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.,Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands
| | | | - Mark La Meir
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands.,Department of Cardiothoracic Surgery, UZ Brussels, Brussels, Belgium
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Petersen J, Pecha S. What we need to do so that the glass is more than half full in stand-alone thoracoscopic ablation. Eur J Cardiothorac Surg 2021; 60:857-858. [PMID: 34324653 DOI: 10.1093/ejcts/ezab351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/24/2021] [Accepted: 07/04/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Johannes Petersen
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
| | - Simon Pecha
- Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany
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van Laar C, Bentala M, Weimar T, Doll N, Swaans MJ, Molhoek SG, Hofman FN, Kelder J, van Putte BP. Thoracoscopic ablation for the treatment of atrial fibrillation: a systematic outcome analysis of a multicentre cohort. Europace 2020; 21:893-899. [PMID: 30689852 DOI: 10.1093/europace/euy323] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/21/2018] [Indexed: 11/13/2022] Open
Abstract
AIMS To perform a systematic outcome analysis in order to provide cardiologists and general pactitioners with more adequate information to guide their decision making regarding rhythm control. Totally thoracoscopic maze (TTmaze) for the treatment of atrial fibrillation (AF) is recommended as a Class 2a indication mainly based on single centre studies including small patient cohorts and inconsistent lesion sets. METHODS AND RESULTS We studied consecutive patients undergoing TTmaze in three European referral centres (2012-15). Primary outcome was freedom from atrial tachyarrhythmia (ATA). Secondary outcomes were 30-day complications, the composite endpoint of ischaemic stroke, haemorrhagic stroke or transient ischaemic attack (TIA), all-cause mortality, and predictors of ATA recurrence. Four hundred and seventy-five patients were included, with a mean age of 61 ± 9 years and 69.5% male. The mean CHA2DS2-VASc score was 1.7 ± 1.3. The overall freedom from ATA was 68.8% after a mean follow-up period of 20 ± 9 months. Freedom from ATA was 72.7% for paroxysmal AF, 68.9% for persistent AF, and 54.2% for longstanding persistent AF. Multivariate analysis revealed female gender [hazard ratio (HR): 1.87, P = 0.005], in-hospital AF (HR: 1.95, P = 0.040), longer duration of preoperative AF (HR: 1.06, P = 0.003) and mitral regurgitation (HR: 1.84, P = 0.025) as independent predictors of ATA recurrence. Overall 30-day freedom from any complication was 92.4%. Freedom from cerebrovascular events after mean follow-up of 30 ± 16 months was 98.7% and overall survival was 98.3%. The observed rate of ischaemic stroke, haemorrhagic stroke, or TIA was low (0.5 per 100 patient-years). CONCLUSION Totally thoracoscopic maze is a safe and effective rhythm control therapy.
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Affiliation(s)
- Charlotte van Laar
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Koekoekslaan 1, CM Nieuwegein, the Netherlands
| | - Mohamed Bentala
- Department of Cardiothoracic Surgery, Amphia Hospital, Molengracht 21, CK Breda, the Netherlands
| | - Timo Weimar
- Sana HerzchirurgischeKlinik Stuttgart GmbH, Department of Cardiac Surgery, Herdweg 2, Stuttgart, Baden-Württemberg, Germany
| | - Nicolas Doll
- Sana HerzchirurgischeKlinik Stuttgart GmbH, Department of Cardiac Surgery, Herdweg 2, Stuttgart, Baden-Württemberg, Germany
| | - Martin J Swaans
- Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, CM Nieuwegein, the Netherlands
| | - Sander G Molhoek
- Department of Cardiology, Amphia Hospital, Molengracht 21, CK Breda, the Netherlands
| | - Frederik N Hofman
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Koekoekslaan 1, CM Nieuwegein, the Netherlands
| | - Johannes Kelder
- St. Antonius Hospital, Department of Research & Development, Koekoekslaan 1, CM Nieuwegein, the Netherlands
| | - Bart P van Putte
- Department of Cardiothoracic Surgery, St. Antonius Hospital, Koekoekslaan 1, CM Nieuwegein, the Netherlands.,Department of Cardiothoracic Surgery, Academic Medical Center, Meibergdreef 9, AZ Amsterdam, the Netherlands
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Geuzebroek GSC, Bentala M, Molhoek SG, Kelder JC, Schaap J, Van Putte BP. Totally thoracoscopic left atrial Maze: standardized, effective and safe. Interact Cardiovasc Thorac Surg 2015; 22:259-64. [PMID: 26705300 DOI: 10.1093/icvts/ivv358] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 11/18/2015] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES The totally thoracoscopic left atrial Maze (TT-Maze) is a relatively new surgical solution for the treatment of atrial fibrillation (AF). The procedure consists of a complete left atrial Maze, which is performed by video-assisted thoracoscopy with the use of radiofrequency ablation. We describe our rhythm results as well as our learning curve experience of the TT-Maze. METHODS To evaluate the learning curve, all consecutive patients who underwent a TT-Maze and were operated by one surgeon (Bart P. Van Putte) were included in the study. The endpoint of surgery was sinus rhythm with a bidirectional block of the box and pulmonary veins. RESULTS A total of 83 patients were included. Fifty percent of the patients had paroxysmal AF. The mean indexed left atrial volume was 44 ± 15 ml/m(2) and 38% of the patients had a previous catheter ablation for AF. During a mean follow-up of 10.9 ± 4.9 months, there were no major events. At latest follow-up, 82% of the patients did not have a single registration of AF or other atrial tachyarrhythmias longer than 30 s. Patients without AF were also free from anti-arrhythmic drugs in 90% of the cases, free from coumadins or direct oral anticoagulants in 63% of the cases and free from both in 58% of the cases. CONCLUSIONS After almost 1-year follow-up, the TT-Maze is proved to be a successful, safe and reproducible strategy for the treatment of all types of AF including patients with enlarged left atria and previously failed catheter ablation.
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Affiliation(s)
| | - Mohamed Bentala
- Department of Cardio-Thoracic Surgery, Amphia Hospital, Breda, Netherlands
| | | | - Johannes C Kelder
- Department of Cardio-Thoracic Surgery, St Antonius Hospital, Nieuwegein, Netherlands
| | - Jeroen Schaap
- Department of Cardiology, Amphia Hospital, Breda, Netherlands
| | - Bart P Van Putte
- Department of Cardio-Thoracic Surgery, St Antonius Hospital, Nieuwegein, Netherlands Department of Cardio-Thoracic Surgery, Amphia Hospital, Breda, Netherlands
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Im SI, Jeong DS, Park SJ, Park KM, Huh J, Kim JS, On YK. Safety of dabigatran or rivaroxaban for thoracoscopic ablation in patients with atrial fibrillation. Int J Cardiol 2015; 186:213-5. [PMID: 25828118 DOI: 10.1016/j.ijcard.2015.03.229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 03/17/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Sung Il Im
- Division of Cardiology, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, Republic of Korea
| | - Dong Seop Jeong
- Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Seung-Jung Park
- Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kyoung-Min Park
- Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - June Huh
- Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - June Soo Kim
- Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Keun On
- Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
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