Ablation of Ganglionic Plexi During Combined Surgery for Atrial Fibrillation

Doll, Nicolas; Pritzwald-Stegmann, Patrick; Czesla, Markus; Kempfert, Joerg; Stenzel, Monika Anna; Borger, Michael A.; Mohr, Friedrich–Wilhelm

doi:10.1016/j.athoracsur.2008.06.077

Cited by 37 publications

(13 citation statements)

References 8 publications

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“…22 Nonetheless, the combination of techniques has shown good clinical results. 23 Our study shows that, when both AADs and additional transcatheter PVI are considered, 91% of our population is free from atrial arrhythmia. In our experience, the feasibility and the encouraging results of repeated percutaneous ablation after failed SMI-PVI suggest that the two procedures may perform well in a sequential multidisciplinary context.…”

Section: Discussionmentioning

confidence: 93%

Surgical Minimally Invasive Pulmonary Vein Isolation for Lone Atrial Fibrillation

Maat

Pozzoli

Scholten

et al. 2013

Innovations�(Phila)

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Objective Minimally invasive surgical pulmonary vein isolation (SMI-PVI) is an emerging therapy for the treatment of symptomatic drug-refractory atrial fibrillation (AF). Nevertheless, the midterm and long-term results of SMI-PVI remain unknown. The aim of this retrospective multicenter study was to report on midterm efficacy and safety of SMI-PVI. Methods The study design was retrospective, multicentric, and observational. From July 2005 to November 2011, a total of 86 patients with drug-refractory paroxysmal or persistent AF underwent SMI-PVI in three centers. Patients were eligible for SMI-PVI if they had symptomatic, drug-refractory AF or after failed transcatheter pulmonary vein isolation. Success was defined as absence of AF on 24- or 96-hour Holter monitoring during follow-up, in the absence of antiarrhythmic drugs (AADs). Results The mean ± SD age was 54 ± 11 years, and 78% were men. The median AF duration was 30 months (range, 2–203); paroxysmal AF was present in 86% of the patients, persistent in 14%. Fifteen patients (17%) underwent previous transcatheter ablations. After a median follow-up of 24 months (range, 6–78), 72% of all patients were free from atrial arrhythmias without the use of AADs. With AADs, this was 83%. Major perioperative adverse events occurred in 7 patients (8%). Conclusions This retrospective multicenter study shows that SMI-PVI is effective at a median follow-up of 24 months for the treatment of mostly paroxysmal drug-refractory AF. Perioperative adverse events do remain a point of caution.

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Section: Discussionmentioning

confidence: 93%

Surgical Minimally Invasive Pulmonary Vein Isolation for Lone Atrial Fibrillation

Maat

Pozzoli

Scholten

et al. 2013

Innovations�(Phila)

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“…A survey was conducted of 5 such studies from independent surgical investigators [60–64], showed success rates ranging from 83 to 93% with follow-up periods spanning 6 to 13 months. Most of these patients had persistent or long standing persistent AF.…”

Section: Combined Methods For Catheter Ablation Of Af: Gp Ablationmentioning

confidence: 99%

The Intrinsic Autonomic Nervous System in Atrial Fibrillation: A Review

Scherlag

Nakagawa

et al. 2012

ISRN Cardiology

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The procedure of catheter ablation for the treatment of drug resistant atrial fibrillation (AF) has evolved but still relies on lesion sets intended to isolate areas of focal firing, mainly the myocardial sleeves of the pulmonary veins (PVs), from the rest of the atria. However the success rates for this procedure have varied inversely with the type of AF. At best success rates have been 20 to 30% below that of other catheter ablation procedures for Wolff-Parkinson-White syndrome, atrioventricular junctional re-entrant tachycardia and atrial flutter. Basic and clinical evidence has emerged suggesting a critical role of the ganglionated plexi (GP) at the PV-atrial junctions in the initiation and maintenance of the focal form of AF. At present the highest success rates have been obtained with the combination of PV isolation and GP ablation both as catheter ablation or minimally invasive surgical procedures. Various lines of evidence from earlier and more recent reports provide that both neurally based and myocardially based forms of AF can separately dominate or coexist within the context of atrial remodeling. Future studies are focusing on non-pharmacological, non-ablative approaches for the prevention and treatment of AF in order to avoid the substantive complications of both these regimens.

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“…Several clinical studies, performed endocardially by catheter ablation [36][37][38][39] or epicardially by minimally invasive surgical techniques [40][41][42][43], have shown that the addition of GP ablation to the established procedure of PV isolation increases the overall success rate for AF "cure" by as much as 20%. However, the addition of roof lesion lines, mitral isthmus lines, and multiple site CFAE ablation tends to promote iatrogenic arrhythmia formation.…”

Section: The Autonomic Nervous System and Atrial Fibrillationmentioning

confidence: 99%

Non-Pharmacological, Non-Ablative Approaches for the Treatment of Atrial Fibrillation: Experimental Evidence and Potential Clinical Implications

Scherlag

Nakagawa

Jackman

et al. 2010

J. of Cardiovasc. Trans. Res.

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In this review, we initially covered the basic and clinical reports that provided the prevalent concepts underlying the mechanisms for atrial fibrillation (AF). The clinical evolution of catheter ablation and its eventual application to AF has also been detailed. A critique of the results based on a review of the literature has shown that either or both drugs or catheter ablation therapy for preventing AF recurrences have significant limitations and even serious complications. Finally, we have presented recent experimental studies which suggest that an alternative approach to reducing AF inducibility can be achieved with low-level autonomic nerve stimulation. Specifically, electrical stimulation of the vago-sympathetic trunks, at levels well below that which slows the heart rate can significantly increase AF thresholds and suppress AF inducibility. Further studies will determine if this new method can be used as an effective means of treating some forms of clinical AF.

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Ablation of Ganglionic Plexi During Combined Surgery for Atrial Fibrillation

Cited by 37 publications

References 8 publications

Surgical Minimally Invasive Pulmonary Vein Isolation for Lone Atrial Fibrillation

Surgical Minimally Invasive Pulmonary Vein Isolation for Lone Atrial Fibrillation

The Intrinsic Autonomic Nervous System in Atrial Fibrillation: A Review

Non-Pharmacological, Non-Ablative Approaches for the Treatment of Atrial Fibrillation: Experimental Evidence and Potential Clinical Implications

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