A Multidisciplinary Approach to the Minimally Invasive Pulmonary Vein Isolation for Treatment of Atrial Fibrillation (original) (raw)
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European Journal of Cardio-Thoracic Surgery, 2010
Objective: Percutaneous catheter pulmonary vein isolation (PVI) has been the preferred choice for invasive treatment of symptomatic, drugrefractory lone atrial fibrillation (AF). Incomplete ablation lines, procedure-related morbidity and long-term success remain, however, a problem. A minimally invasive surgical approach can provide an attractive and secure alternative. Surgery offers an epicardial, bipolar approach under direct vision, but the invasiveness of surgery remains a problem. Therefore, we developed a completely thoracoscopic procedure. The objective of this study was to assess the feasibility, safety and effectiveness of a completely thoracoscopic surgical procedure to cure lone AF. Methods: Bilateral 'video-assisted thoracoscopy' was performed to isolate the bilateral pairs of pulmonary veins using bipolar RF-energy, to ablate the ganglionic plexus (GP) and to amputate the left atrial appendage. Preoperative, in-hospital and follow-up data were collected for our first 30 patients. Results: AF was paroxysmal in 63%, persistent in 27% and permanent in 10% of cases. The mean (AESD) left atrial diameter was 42.1 AE 7.4 mm and the mean duration of AF was 79.0 AE 63.9 months. Freedom from AF was obtained in 77% of the patients during a mean followup of 11.6 months. Forty-three percent of the patients had previously undergone a percutaneous PVI and were all free from AF during follow-up. Mean operation time was 137.4 AE 24.7 min. All patients were extubated in the operating room and left the recovery room within 12 h. The mean hospital stay was 5.1 AE 1.8 days. Two patients ultimately underwent a median sternotomy. No CVAs or pacemaker implantation were identified and none of the patients died. Conclusion: We report our initial experience of a completely thoracoscopic PVI with GP-ablation and amputation of the left atrial appendage and demonstrate that the procedure is feasible, safe and effective for the treatment of lone AF. #
European Heart Journal, 2005
Aims Anatomical and wide atrial encircling of the pulmonary veins (PVs) has been proposed as a cure of atrial fibrillation (AF). We evaluated the acute achievement of electrical PV isolation using this approach. In addition, the consequences of wide encircling of the PVs with isolation were assessed. Methods and results Twenty patients with paroxysmal AF were studied. Anatomically guided ablation was performed utilizing the CARTO system to deliver coalescent lesions circumferentially around each PV to produce a voltage reduction to ,0.1 mV, with the operator blinded to recordings of circumferential PV mapping. After achieving the anatomical endpoint, the incidence of residual conduction and the amplitude and conduction delay of residual PV potentials were determined. Electrical isolation of the PV was then performed and the residual far-field potentials evaluated. Individual PV ablation was performed in all PVs. Anatomically guided PV ablation was performed for 47.3 + 11 min, after which 44 (55%) PVs were electrically isolated. In the remaining 45%, despite abolition of the local potential at the ablation site, PV potentials [amplitude 0.2 mV (range 0.09-0.75) and delay of 50.3 + 12.6 ms] were identified by circumferential mapping. After electrical isolation (12.2 + 11.7 min ablation), 55 (69%) PVs demonstrated far-field potentials; with a greater incidence (P ¼ 0.015) and amplitude (P ¼ 0.021) on the left compared with the right PVs. At 13.2 + 8.3 months follow-up, 13 patients (65%) remained arrhythmia-free without anti-arrhythmics. In four patients (20%), spontaneous sustained left atrial macrore-entry required re-mapping and ablation. Macrore-entry was observed to utilize regions around or bordering the previous ablation as its substrate. Conclusion Anatomically guided circumferential PV ablation results in apparently coalescent but electrically incomplete lesions with residual conduction in 45% of PVs. Wide encircling of the PVs was associated with left atrial macrore-entry in 20% of patients.
Journal of Cardiovascular Development and Disease, 2022
Background: Left atrial tachycardias (LAT) are a well-known outcome of pulmonary vein isolation (PVI). Few data are available on whether the catheter used to perform PVI influences the incidence, as well as the characteristics of post PVI LAT. We present data on LAT following PVI by the following three ablation technologies: (1) phased multi-electrode radiofrequency catheter (PVAC), (2) irrigated single-tip catheter (iRF), and (3) cryoballoon ablation. Methods: Using a prospectively designed single-center database, we analyzed 650 patients (300 iRF, 150 PVAC, and 200 cryoballoon) with paroxysmal (n = 401) and persistent atrial fibrillation (AF), who underwent their first PVI at our center. Results: The three populations were comparable in their baseline characteristics; however, the cryoballoon group comprised a higher percentage of patients with persistent AF (p = 0.05). The LAT rates were 3.7% in the iRF group (mean follow-up 22 ± 14 months), 0.7% in the PVAC group (mean follow-up...
Circulation. Arrhythmia and electrophysiology, 2011
Thoracoscopic pulmonary vein isolation (PVI) and ganglionated plexus ablation is a novel approach in the treatment of atrial fibrillation (AF). We hypothesize that meticulous electrophysiological confirmation of PVI results in fewer recurrences of AF during follow-up. Surgery was performed through 3 ports bilaterally. Ganglionated plexi were localized and subsequently ablated. PVI was performed and entry and exit block was confirmed. Additional left atrial ablation lines were created and conduction block verified in patients with nonparoxysmal AF. The left atrial appendage was removed. Freedom of AF was assessed by ECGs and Holter monitoring every 3 months or during symptoms of arrhythmia. Antiarrhythmic drugs were discontinued after 3 months and oral anticoagulants were discontinued according to the guidelines. Thirty-one patients were treated (16 paroxysmal AF, 13 persistent AF, 2 long-standing persistent AF). Thirteen patients with nonparoxysmal received additional left atrial ab...
Pulmonary vein isolation and linear lesions in atrial fibrillation ablation
Journal of Interventional Cardiac Electrophysiology, 2007
Background Various strategies have been used for atrial fibrillation (AF) ablation. It is unclear whether adding linear lesions to pulmonary vein (PV) isolation has significant advantages. Objectives We assessed the clinical benefit of adding linear lesions in patients undergoing PV isolation for AF. Methods One hundred patients (63 male and 37 female; mean age of 59±11 years) with documented paroxysmal AF were included in the study. Patients were randomized into two groups. The first group underwent PV isolation alone. The second group underwent PV isolation and had two linear lesions created; one line between the superior PVs, and a second line from the left inferior PV to the mitral valve annulus. Patients' clinical progress after the ablation was evaluated and compared at 1, 3, and 9 months after their respective ablation procedures. Results The linear lesions group maintained sinus rhythm and had fewer symptoms than the lone PV isolation group (86 vs. 58%, respectively) (p<0.05) at 1 month. At 9 months, when patients who reverted to AF underwent additional management to regain sinus rhythm (90 vs. 82%, respectively) (p=NS), there was no statistical difference between the groups regarding the use of antiarrhythmics, the need for electrical cardioversion, and subjective improvement. Conclusion The addition of linear lesions to PV isolation more effectively achieved sinus rhythm initially and fewer patients required additional management to maintain their rhythm when compared to patients who underwent lone PV isolation. However, at 9 months, the overall results were similar in both groups.