CEA as an initial management strategy could reduce the risk of death and major cerebrovascular events when added to MMT.

Objective: To evaluate the efficacy and safety of a modified technique for totally thoracoscopic left atrial posterior wall and pulmonary vein isolation in patients with long-standing persistent atrial fibrillation. Methods: From April 2017 to December 2018, we included in this study 28 consecutive patients who underwent thoracoscopic left atrial posterior wall and pulmonary vein radiofrequency isolation combined with left atrial appendage resection. We used a device with irrigated electrodes (Medtronic Cardioblate Gemini-s). The original surgical technique "GALAXY" proposed by Doty in 2012 was modified. The number of ablations was significantly increased, and frequent position changing of the ablation device and change of device angulation were added. Results: Sinus rhythm was restored in all patients. There was no operative mortality, no myocardial infarction, and no stroke or transient ischemic attack. One patient required sternotomy and another survived left anterolateral thoracotomy due to bleeding. A 180-day follow-up (24-hour Holter monitoring) revealed no sign of recurrence of atrial fibrillation or other supraventricular arrhythmia in any patient. Mean follow-up was nine months (range: 6-16 months). At the last follow-up, 26 patients (92,9%) were in sinus rhythm (24-hour Holter monitoring). Conclusion: A frequent ablation device position changing during the surgery makes it possible to achieve complete left atrial posterior wall and pulmonary veins isolation. An increased number of applications allows to avoid a false positive transmural damage assessment showed by impedance drop. Also, frequent position changing of the ablation device and increased number of applications do not affect the number of postoperative complications.

научно-клинический центр специализированных видов медицинской помощи и медицинских технологий» ФМБА России, 2 ФГБУ «Государственный научный центр Российской Федерации-Федеральный медицинский биофизический центр имени А.И.Бурназяна» ФМБА России Описываются методы неинвазивной протонно-лучевой аблации аритмогенного субстрата желудочковых тахикардий у больных со структурной патологией сердца направленные на устранение триггеров и/или разрушение re-entry механизмов при помощи пучка протонов.

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Introduction We propose a new technique for box-lesion ablation combined with off-pump coronary artery bypass grafting for the treatment of patients with coronary artery disease and paroxysmal or persistent atrial fibrillation. Methods Eight male patients with paroxysmal (n=2) or persistent atrial fibrillation (n=6) and coronary artery disease underwent box-lesion ablation combined with off-pump coronary artery bypass grafting. Box-lesion ablation was performed using a bipolar flexible clamping device with irrigated electrodes which was originally designed for thoracoscopic epicardial ablation. Results Complete revascularization was performed in all patients. There were no deaths or major complications. At a median follow-up of 14 months, seven patients (87.5%) were in sinus rhythm. Conclusion Box-lesion ablation can be easily and effectively combined with coronary artery surgery in an off-pump setting.