Invasive Surgical Ablation Research Articles

Short- and long-term outcomes in isolated vs. hybrid thoracoscopic ablation in patients with atrial fibrillation: a systematic review and reconstructed individual patient data meta-analysis.

Both isolated thoracoscopic and hybrid thoracoscopic atrial fibrillation (AF) ablation techniques have demonstrated favourable outcomes in the management of patients with (long-standing) persistent AF, as compared with catheter ablation. However, it is currently unknown whether there is a difference in short- and long-term outcomes when comparing these two minimally invasive surgical AF ablation procedures. Therefore, a systematic review and meta-analysis were performed to investigate these two techniques, with a specific emphasis on long-term freedom from atrial tachyarrhythmias (ATAs). A systematic search through PubMed, EMBASE, and the Cochrane Library databases was performed. All studies reporting on short-term outcomes were included in the meta-analysis. A pooled analysis of long-term freedom from ATA was performed based on Kaplan-Meier (KM) curve-derived individual patient data. Reconstructed individual time-to-event data were analysed in a multivariable Cox frailty model with adjustments for age, sex, type of AF, duration of AF history, and study variable (frailty term in the frailty Cox model). In total, 53 studies were included in the meta-analysis, encompassing 4950 patients. There were no differences in major short-term outcomes (mortality or stroke) between isolated thoracoscopic and hybrid thoracoscopic ablation. A total of 18 studies reported KM curves for long-term freedom from ATA, comprising 2038 patients. Adjusted analysis revealed that hybrid ablation was significantly associated with greater freedom from ATA [adjusted hazard ratio (aHR) = 0.59, 95% confidence interval (CI): 0.43-0.83, P < 0.001] compared with isolated thoracoscopic ablation. Additionally, older age (aHR = 1.07, 95% CI: 1.03-1.12, P = 0.002) and a higher percentage of male patients (aHR = 1.02, 95% CI: 1.01-1.03, P < 0.001) were significantly associated with lower long-term freedom from ATA recurrence. Hybrid thoracoscopic AF ablation is associated with a greater long-term freedom from ATA when compared with isolated thoracoscopic ablation, without differences in complications.

The hybrid ablation approach to treating long-standing persistent atrial fibrillation: real-world data from a tertiary institution

Abstract Background Pulmonary vein isolation(PVI) is effective treatment for atrial fibrillation(AF) but efficacy of endocardial ablation-alone for long-standing persistent AF is limited(1). Hybrid AF ablation may offer better outcomes but studies were on patients with paroxysmal/persistent-AF(2) and relied on Holter-alone to assess recurrences(3). Our hybrid-AF ablation patients were all long-standing persistent cases and monitored with implantable loop recorders(ILR). Aim Evaluate long-term outcomes of hybrid-AF ablation using ILR data. Methods The hybrid approach at our institution consisted of a first-stage minimally invasive surgical epicardial ablation of the left atrial posterior wall via radiofrequency (RF) ablation. An ILR was implanted at the same setting. A few months later, the second-stage endocardial catheter ablation was performed to ensure PVI and ‘touch-up’ of any residual conduction gaps in the left atrium. All epicardial ablation cases were performed at the cardiothoracic operating-room in our tertiary hospital (‘hub’) whilst the endocardial RF-cases were performed at either the hub or satellite centre(‘spoke’) as part of our institution’s ‘hub-and-spoke’ model. Inclusion criteria for hybrid AF-ablation were long-standing persistent AF, body mass index (BMI) &amp;lt;40 and standard indications for AF ablation as per ESC 2020 AF guidelines(4). Once both aspects of the hybrid approach were completed, patients were followed up in ILR remote monitoring clinics. AF recurrence was defined as AF/atrial tachycardia(AT) lasting &amp;gt;30s. All data were obtained retrospectively via hospital electronic patient records. Results 38 consecutive patients completed both aspects of hybrid ablation between December 2017-August 2023 with mean follow up of 19±13months(mean±SD). Baseline data, procedure characteristics and details of complications are shown in Table 1. ILR data was obtained in 36/38 patients(ILR implantation precluded in one due to previous breast cancer surgery. One had ILR battery depletion contributed by significant delay between the 2 stages of the hybrid ablation). AF/AT recurred in one third of patients during the blanking period(3 months) whilst 45% remained in sinus rhythm at 1-year; at 2yrs, 39% maintained SR and 25% at 3yrs (Figure 1). Post-hybrid ablation, two patients underwent re-do AF/AT ablation. The relatively high recurrence rate compared to other studies may be due to: very long duration of AF prior to hybrid-ablation(7.0±3.6years), significant delay between both stages of the procedure(9±11months) due to the pandemic and competing waiting list pressures, multiple comorbidities (82% had &amp;gt;2 comorbidities, 42% were obese) and the higher arrhythmia pickup rate with ILRs compared with intermittent rhythm monitoring. Conclusion Our study provides real world insight into the challenges of delivering a hybrid AF ablation service but highlights its utility in long-standing persistent AF patients.Table 1Figure 1

Rhythm outcomes of minimally-invasive off-pump surgical versus catheter ablation in atrial fibrillation: A meta-analysis of reconstructed time-to-event data

Rhythm outcomes of minimally-invasive off-pump surgical versus catheter ablation in atrial fibrillation: A meta-analysis of reconstructed time-to-event data

Percutaneous or mini-invasive surgical radiofrequency re-ablation of atrial fibrillation: Impact on atrial function and echocardiographic predictors of short and long-term success.

The aim of this study was to compare percutaneous catheter ablation vs. minimally invasive surgical ablation, evaluating the impact of repeated ablation on atrial function, and evaluating predictors of atrial fibrillation (AF) recurrence. When AF ablation fails, re-ablations are required in up to 40% of patients to treat recurrent arrhythmia; surgical ablation is more effective than catheter ablation. Thirty-two patients with failed prior catheter ablation and referred for a second ablation (18 catheter and 14 surgical) were included in a descriptive observational study. Left atrial volumes, strain, and strain rate were measured with 2D speckle tracking echocardiography at baseline and 6 months after the procedures to assess left atrial functions. Patients received up to 1 year of clinical and Holter follow-up. At the 12-month follow-up, catheter ablation was effective in 56% and surgical ablation in 72% of patients (OR 2 (CI 0.45-8.84), p 0.36). Left atrial booster function was similar in all patients, but left atrial reservoir function was more impaired in those patients who underwent surgical ablation. Left atrial booster function was predictive of arrhythmia recurrence after both catheter and surgical ablation: late diastolic strain rate (LASRa) cut-off ≤ -0.89 s-1 (sensitivity 88%, specificity 70%, AUC 0.82) and ≤ -0.85 s-1 (sensitivity 60%, specificity 100%, AUC 0.82), respectively. Surgical ablation has a more negative impact on LA reservoir function despite being slightly more effective in arrhythmia suppression. LA booster function is not significantly impaired by either procedure. LA booster function predicts arrhythmia elimination after a re-ablation (catheter or surgical).

Hybrid Convergent ablation for atrial fibrillation: A systematic review and meta-analysis.

BackgroundHybrid Convergent ablation for atrial fibrillation (AF) combines minimally invasive surgical (epicardial) and catheter (endocardial) ablation. The procedural goal is to achieve more extensive, enduring ablation of AF substrate around the pulmonary veins, posterior wall, and vestibule of the posterior wall left atrium.ObjectiveTo perform a systematic review and meta-analysis on safety and effectiveness of contemporary Hybrid Convergent procedures.MethodsPubMed, Embase, and manual searches identified primary research articles on Hybrid Convergent. Inclusion criteria focused on contemporary practices (epicardial ablation device and lesions). Clinical outcomes at 1 year or later follow-up, patient population, procedural details, and major adverse events (MAE) were recorded.ResultsOf 249 records, 6 studies (5 observational, 1 randomized controlled trial) including 551 patients were included. Endocardial energy sources included radiofrequency and cryoballoon. Hybrid Convergent ablation was mostly performed in patients with drug-refractory persistent and longstanding persistent AF. Mean preprocedural AF duration ranged between 2 and 5.1 years. Most patients (∼92%) underwent Hybrid Convergent in a single hospitalization. At 1 year follow-up or later, 69% (95% confidence interval [CI]: 61%–78%, n = 523) were free from atrial arrhythmias and 50% (95% CI: 42%–58%, n = 343) were free from atrial arrhythmias off antiarrhythmic drugs. Thirty-day MAE rate was 6% (95% CI: 3%–8%, n = 551).ConclusionHybrid Convergent ablation is an effective ablation strategy for persistent and longstanding persistent AF. Contemporary procedural approaches and published strategies aim to mitigate complications reported in early experience and address delayed inflammatory effusions.

Thoracoscopic surgical ablation versus catheter ablation as first-line treatment for long-standing persistent atrial fibrillation: the CASA-AF RCT

Background Standalone thoracoscopic surgical ablation may be more effective than catheter ablation in patients with long-standing persistent atrial fibrillation. Objectives To determine whether or not surgical ablation is clinically superior to catheter ablation as the first-line treatment strategy in long-standing persistent atrial fibrillation. Design This was a prospective, multicentre, randomised control trial. Setting Four NHS tertiary centres in England. Participants Adults with long-standing persistent atrial fibrillation, who had European Heart Rhythm Association symptom scores &gt; 2 and who were naive to previous catheter ablation or thoracic/cardiac surgery. Interventions Minimally invasive thoracoscopic surgical ablation and conventional catheter ablation (control intervention). Main outcome measures The primary outcome was freedom from atrial fibrillation/tachycardia ≥ 30 seconds after a single procedure without antiarrhythmic drugs (class 1C/3) at 1 year, excluding a 3-month blanking period. The secondary outcomes include the intervention-related major complication rate; clinical success (≥ 75% reduction in arrhythmia burden); and changes in symptoms, quality of life and cost-effectiveness. Methods Patients (n = 120) were randomised to surgical ablation (n = 60) or catheter ablation (n = 60). An implanted loop recorder provided continuous cardiac monitoring following ablation. Follow-up visits were at 3, 6, 9 and 12 months. Loop recorder data were reviewed monthly by a physiologist who was blinded to the randomisation outcome. Results The study treatment was received by 55 patients in the surgical ablation arm and 60 patients in the catheter ablation arm; five patients withdrew from surgical ablation before treatment. Data from randomised and treated patients were analysed as per intention to treat. Patients had a mean age of 62.3 (standard deviation 9.6) years, were predominantly male (74%), had a mean left atrial diameter of 44.6 mm (standard deviation 6 mm) and were in continuous atrial fibrillation for 22 months (range 16–31 months). At 12 months, 26% of patients in the surgical ablation arm (14/54) and 28% of patients in the catheter ablation arm (17/60) were free from atrial arrhythmias after a single procedure without antiarrhythmic drugs (odds ratio 1.13, 95% confidence interval 0.46 to 2.83; p = 0.84). An arrhythmia burden reduction of ≥ 75% was seen in 36 out of 54 (67%) patients in the surgical ablation arm, compared with 46 out of 60 (77%) patients in the catheter ablation arm (odds ratio 1.64, 95% confidence interval 0.67 to 4.08; p = 0.3). Procedure-related serious complications within 30 days of the intervention occurred in 15% (8/55) of patients in the surgical ablation arm (including one death) compared with 10% (6/60) of patients in the catheter ablation arm (p = 0.46). Surgical ablation was associated with significantly higher costs (£23,221 vs. £18,186; p = 0.02) and fewer quality-adjusted life-years than catheter ablation (0.76 vs. 0.83; p = 0.02). Limitations This study was conducted in four highly specialised cardiology centres that have substantial experience in both treatment modalities; therefore, the results may not be widely generalisable. The study was not powered to detect small differences in efficacy. Conclusions We found no evidence to suggest that standalone thoracoscopic surgical ablation outcomes were superior to catheter ablation outcomes in achieving freedom from atrial arrhythmia after a single procedure without antiarrhythmic drugs. Moreover, surgical ablation is associated with a longer hospital stay, smaller improvements in quality of life and higher health-care costs than catheter ablation (standard care therapy). Future work Evaluation of the impact of ablation treatments on sinus rhythm maintenance and quality of life with extended follow-up to 3 years. Model-based economic analysis to estimate long-term benefits, harms and costs of surgical and catheter ablation compared with antiarrhythmic drug therapy in long-standing persistent atrial fibrillation patients. Trial registration Current Controlled Trials ISRCTN18250790 and ClinicalTrials.gov NCT02755688. Funding This project was funded by the Efficacy and Mechanism Evaluation (EME) programme, a Medical Research Council (MRC) and National Institute for Health Research (NIHR) partnership. This study was supported by the UK Clinical Research Collaboration-registered King’s Clinical Trials Unit at King’s Health Partners, which is part funded by the NIHR Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and King’s College London and the NIHR Evaluation, Trials and Studies Coordinating Centre. This will be published in full in Efficacy and Mechanism Evaluation; Vol. 8, No. 18. See the NIHR Journals Library website for further project information.

Spectrum of arrhythmogenic substrate post minimally invasive maze surgery in patients with recurrent.

Advancements in minimally invasive surgical ablation (MISA) have focused on improving pulmonary vein isolation. Additional ablation targets have been developed (such as posterior wall isolation). The mid- and long-term effects of current techniques (including electrophysiologic findings and recurrent arrhythmia mechanisms) have not previously been reported. Twenty eight patients with recurrent atrial arrhythmias after bipolar clamp ablation of the pulmonary vein antrum, ganglionated plexi, posterior wall isolation (roof and floor lines to create a posterior box), and ligament of Marshall ligation/cauterization and left atrial appendage clipping underwent follow up electrophysiology study including left atrial mapping an average of 2.3 years postoperatively. Atrial fibrillation was the most common recurrent arrhythmia (n=18) followed by micro-reentrant atrial tachycardia (n=5), macro-reentry left atrial flutter (n=3), and typical cavo-tricuspid isthmus atrial flutter (n=2). Eighty six of 112 (77%) PVs mapped were electrically isolated, 16 (57%) patients had all four pulmonary veins (PVs) isolated. The posterior wall (PW) was completely isolated in only four (14%) patients, seven (25%) patients had normal PW voltage, while 17 (61%) patients had abnormal delayed or fractionated electrograms in the posterior wall (incomplete isolation). Abnormal PW electrograms were more frequently found in patients with complex recurrent left atrial arrhythmia (micro-reentry or left atrial macro-reentry flutter). With current surgical techniques PV isolation has improved, but PW isolation remains challenging. Incomplete PW isolation may produce arrhythmogenic substrate.

Patch-Clamp Recordings of Action Potentials From Human Atrial Myocytes: Optimization Through Dynamic Clamp.

Introduction: Atrial fibrillation (AF) is the most common cardiac arrhythmia. Consequently, novel therapies are being developed. Ultimately, the impact of compounds on the action potential (AP) needs to be tested in freshly isolated human atrial myocytes. However, the frequent depolarized state of these cells upon isolation seriously hampers reliable AP recordings. Purpose: We assessed whether AP recordings from single human atrial myocytes could be improved by providing these cells with a proper inward rectifier K+ current (IK1), and consequently with a regular, non-depolarized resting membrane potential (RMP), through “dynamic clamp”. Methods: Single myocytes were enzymatically isolated from left atrial appendage tissue obtained from patients with paroxysmal AF undergoing minimally invasive surgical ablation. APs were elicited at 1 Hz and measured using perforated patch-clamp methodology, injecting a synthetic IK1 to generate a regular RMP. The injected IK1 had strong or moderate rectification. For comparison, a regular RMP was forced through injection of a constant outward current. A wide variety of ion channel blockers was tested to assess their modulatory effects on AP characteristics. Results: Without any current injection, RMPs ranged from −9.6 to −86.2 mV in 58 cells. In depolarized cells (RMP positive to −60 mV), RMP could be set at −80 mV using IK1 or constant current injection and APs could be evoked upon stimulation. AP duration differed significantly between current injection methods (p < 0.05) and was shortest with constant current injection and longest with injection of IK1 with strong rectification. With moderate rectification, AP duration at 90% repolarization (APD90) was similar to myocytes with regular non-depolarized RMP, suggesting that a synthetic IK1 with moderate rectification is the most appropriate for human atrial myocytes. Importantly, APs evoked using each injection method were still sensitive to all drugs tested (lidocaine, nifedipine, E-4031, low dose 4-aminopyridine, barium, and apamin), suggesting that the major ionic currents of the atrial cells remained functional. However, certain drug effects were quantitatively dependent on the current injection approach used. Conclusion: Injection of a synthetic IK1 with moderate rectification facilitates detailed AP measurements in human atrial myocytes. Therefore, dynamic clamp represents a promising tool for testing novel antiarrhythmic drugs.

Insights from advancements and pathbreaking research on the minimally invasive treatment of atrial fibrillation.

Atrial fibrillation (AF) remains the most common cardiac arrhythmia with increasing prevalence in developed and aging countries. Pharmacological antiarrhythmic therapy has low effectiveness and is limited by its toxicity. Developed in 1987 by James Cox surgical ablation of AF called MAZE procedure was very effective, but due to its invasiveness and complexity was not widely adopted. Landmark research done by Haissaguerre in 1998 initiated a new approach for treatment namely percutaneous catheter ablation, which remains a class I/A indication in symptomatic paroxysmal AF refractory to optimal medical therapy. However, its efficacy in patients with persistent atrial fibrillation (PSAF) is far from satisfactory. Recent advancements in devices and techniques of minimally invasive surgical ablation show very good results in the treatment of PSAF. Current guidelines equate surgical with catheter ablation within the scope of efficacy indicating that both may be considered as an effective and safe treatment option for patients with persistent forms of arrhythmia. The higher efficacy of surgical ablation was confirmed at a 7-year follow-up of FAST trial with recurrence rate as high as 87% in catheter arm compared with 56% in thoracoscopic ablation arm. A new concept of the invasive treatment of AF consisting of combined surgical (epicardial) and electrophysiological (endocardial) was introduced in 2009. Recently experts’ opinions and published data suggest that the proper hybrid treatment consisting of a planned combination of surgical and catheter ablation may give even better results. One of the most invaluable benefits of surgical ablations is the possibility of concomitant occlusion of the left atrial appendage. Recently good results have been reported for the novel epicardial clip for closing the left atrial appendage, which is placed in the deployment loop on a disposable holder.

The Role of the Electrophysiologist in Convergent Ablation.

Catheter ablation is a well-established treatment for patients with AF in whom sinus rhythm is desired. Both radiofrequency catheter ablation and cryoablation are widely performed, rapidly developing techniques. Convergent ablation is a novel hybrid technique combining an endocardial radiofrequency ablation with a minimally invasive epicardial surgical ablation. Some suggest that hybrid ablation may be more effective than lone endocardial ablation in achieving the elusive goal of maintaining sinus rhythm in patients with non-paroxysmal AF. In this article, the authors examine the safety and efficacy of catheter ablation and convergent ablation for long-standing, persistent AF. We also outline the crucial role that electrophysiologists play, not only as a procedure operator, but also as the coordinator and developer of this multidisciplinary service.

CPAP Effects on Oxygen Delivery in One-Lung Ventilation During Minimally Invasive Surgical Ablation for Atrial Fibrillation in The Supine Position

CPAP Effects on Oxygen Delivery in One-Lung Ventilation During Minimally Invasive Surgical Ablation for Atrial Fibrillation in The Supine Position

The convergent procedure versus catheter ablation alone in longstanding persistent atrial fibrillation: A single centre, propensity-matched cohort study

The convergent procedure versus catheter ablation alone in longstanding persistent atrial fibrillation: A single centre, propensity-matched cohort study

Left Atrial Appendage Thrombosis and Persistent Atrial Fibrillation: combined Treatment with a Totally Thoracoscopic Approach.

Minimally invasive surgical ablation is generally contraindicated in patients with atrial fibrillation and thrombosis of the left atrial appendage.We have treated three of these patients using an innovative technique based on a bilateral video-thoracoscopic approach, performing a continuous encircling lesion at the pulmonary veins outflow with radio-frequency ablation, simultaneously excluding the left atrial appendage. The postoperative course was uneventful, without neurologic events and all patients maintained a stable sinus rhythm at 1-year follow-up.This procedure represents a new mini-invasive method to treat persistent atrial fibrillation when partial thrombosis of the left atrial appendage contraindicates other ablation techniques.

Short and Intermediate Term Outcomes of the Convergent Procedure: Initial Experience in a Tertiary Referral Center.

Purpose: The Convergent procedure is a hybrid, multidisciplinary treatment for symptomatic atrial fibrillation (AF) consisting of minimally invasive surgical epicardial ablation and percutaneous/catheter endocardial ablation. We investigated outcomes following introduction of the Convergent procedure at our institution.Methods: Retrospective study examining single-center outcomes. Demographic, procedural, and post-procedural variables were collected with follow-up data obtained at 3, 6, and 12 months.Results: In all, 36 patients with paroxysmal (11%) or persistent/long-standing persistent (89%) AF underwent the Convergent procedure. 36% also underwent concomitant left atrial appendage (LAA) exclusion by thoracoscopic placement of an epicardial clip. Mean age 60.6 ± 8.0 years with mean arrhythmia burden of 3.9 ± 2.7 years. All patients had failed prior attempts at medical management, 81% had failed prior cardioversion, and 17% had failed prior catheter ablation. Convergent was performed successfully in all patients with no peri-procedural deaths or major complications. At 3 and 12 months, 77.8% and 77.3% of patients, respectively, were free from symptomatic arrhythmia. 65.8% were off anti-arrhythmic medication at 12 months.Conclusions: The Convergent procedure is safe and has good short- and intermediate-term clinical success rates. This unique hybrid approach combines strengths of surgical and catheter ablation and should be part of any comprehensive AF treatment program.

VD06 BILATERAL STAGED THORACOSCOPIC SURGICAL TREATMENT OF LONE PERSISTENT ATRIAL FIBRILLATION WITH LEFT ATRIAL APPENDAGE THROMBOSIS

Abstract Particularity of the video: Catheter ablation and minimally invasive surgical ablation have become accepted therapy for atrial fibrillation (AF). The presence of a thrombus in the left atrial appendage (LAA) is considered an exclusion criterion for both approaches and for LAA occlusion. The procedure described could represent a new mini-invasive method to treat AF and exclude the LAA. Brief description: We described a new mini-invasive procedure for a combined radiofrequency treatment of AF and exclusion of LLA with partial thrombosis through a bilateral thoracoscopic approach in a 71-years-old man with AF and partial thrombosis of the LAA. LAA was firstly secured by encircling its base with a 3/0 prolene Ethibinder™. Ablation was obtained by encircling the pulmonary veins origin with Estech-COBRAFusion™ device, delivering both bipolar and monopolar energy. LAA exclusion was finally achieved by deploying the Atricure-AtriClipPRO2™. Postoperative course was uneventful and the patient was discharged in sinus rhythm.

Atrial endocardial expression of von Willebrand factor and thrombomodulin is associated with recurrence after minimally invasive surgical atrial fibrillation ablation.

We retrospectively analysed data from non-valvular atrial fibrillation (AF) patients who underwent minimally invasive surgical AF ablation at our centre. Our purpose was to explore the atrial endocardial expression of von Willebrand factor (vWF) and thrombomodulin (TM) and their association with rhythm results after the procedure. From January 2014 to May 2015, 60 patients underwent minimally invasive surgical AF ablation at our centre. Left atrial appendage samples were obtained during the procedure and immunohistochemistry for endocardial markers including vWF and TM was performed and semi-quantitatively graded. All patients underwent postoperative rhythm documentation at 3, 6, 12 and 24 months. At the 2-year interval, 49 (82%) patients maintained sinus rhythm, and all patients were asymptomatic. Univariate analysis shows that patients with AF recurrence have higher vWF score 2/3 and longer AF duration (P < 0.05). In the multivariate analysis, AF duration, vWF score, TM score, left atrial diameter (LAD) and non-paroxysmal AF are included. The result suggests that higher vWF score 2/3, lower TM score 0/1 and non-paroxysmal AF are statistically significant (P < 0.05). In addition, higher vWF score 2/3 is associated with larger LAD (45.2 ± 5.6 mm vs 41.2 ± 7.6 mm, P = 0.032), while higher TM score 2/3, on the other hand, is associated with smaller LAD (44.6 ± 6.1 mm vs 39.9 ± 7.8 mm, P = 0.032). The Kaplan-Meier analysis shows that higher vWF score 2/3 and lower TM score 0/1 appear to be accompanied with higher recurrence rate (vWF: P = 0.021; TM: P = 0.036). Atrial endocardial expression of vWF and TM might be associated with recurrence after minimally invasive surgical AF ablation. Patients with AF recurrence seem to have elevated vWF expression and decreased TM expression.

Subxiphoid Minimally Invasive Epicardial Ablation (Convergent Procedure) With Left Thoracoscopic Closure of the Left Atrial Appendage

Subxiphoid Minimally Invasive Epicardial Ablation (Convergent Procedure) With Left Thoracoscopic Closure of the Left Atrial Appendage

Correlates of Arrhythmia Recurrence After Hybrid Epi- and Endocardial Radiofrequency Ablation for Persistent Atrial Fibrillation.

Long-term efficacy of catheter-based treatment of persistent atrial fibrillation is unsatisfactory. Minimally invasive surgical ablation techniques have been developed recently, but their efficacy has never been systematically tested. Seventy patients (median age, 63.5 years) with persistent atrial fibrillation underwent epicardial thoracoscopic radiofrequency pulmonary vein isolation, linear ablation, Marshal ligament disruption, and exclusion of the left atrial appendage. The procedure was followed by electroanatomic mapping and ablation (EAM) 2 to 3 months later. Only 76% of patients were in normal sinus rhythm at the beginning of EAM. All 4 pulmonary veins and the left atrium posterior wall were found isolated in 69% and 23% of patients, respectively. Arrhythmia-free survival off antiarrhythmic drugs 12 months after EAM was 77%. Using previously ineffective antiarrhythmic drugs and reablation procedures, arrhythmia free-survival increased to 97% during follow-up (mean, 936±432 days; range, 346-1509 days). The majority of arrhythmia recurrences occurred during the first 12 months after EAM. In a multivariable-adjusted estimates, left atrium volume >165 mL, absent normal sinus rhythm at admission for EAM, and inducibility of any sustained tachyarrhythmia at the end of EAM procedure were identified as independent correlates of atrial fibrillation recurrence. Our report demonstrated that the majority of patients after epicardial ablation, using bipolar radiofrequency instruments, required endocardial catheter ablation to complete the linear ablation lesions and a significant proportion of patients required spot-ablations to complete electric pulmonary vein isolation. Noninducibility of any arrhythmia after a staged hybrid procedure seemed to be the strongest correlate of long-term arrhythmia-free survival. URL: www.ablace.cz. Unique identifier: cz-060520121617.

Delayed Electroanatomic Mapping After Surgical Ablation for Persistent Atrial Fibrillation

Delayed Electroanatomic Mapping After Surgical Ablation for Persistent Atrial Fibrillation

Long-term outcomes of minimally invasive surgical ablation for atrial fibrillation: A single-center experience

Long-term outcomes of minimally invasive surgical ablation for atrial fibrillation: A single-center experience