Completely thoracoscopic pulmonary vein isolation with ganglionic plexus ablation and left atrial appendage amputation for treatment of atrial fibrillation

Yilmaz, Alaaddin; Geuzebroek, Guillaume S.C.; Gründeman, Paul F.; Boersma, Lucas V.A.; Sonker, Uday; Bakker, Jacques M.T. de; Boven, Wim-Jan van

doi:10.1016/j.ejcts.2010.01.058

Cited by 74 publications

(79 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…2,3 Minimally invasive SA single-center success rates have been reported to be between 75% and 92% in selected populations. [11][12][13][14][15] In our study, in a population of patients with failed prior CA and/or dilated atria and hypertension, 15 SA was found to be superior to CA in achieving freedom from LA arrhythmia after a 12-month follow-up, albeit at the cost of a higher adverse event rate.…”

Section: Discussionmentioning

confidence: 87%

“…Several smaller series have been promising in this respect. [11][12][13][14][15] However, the procedural SA adverse event rate of 23.0% was clearly higher than that of CA. These SA complications tended to result mostly from direct mechanical injury during the procedure.…”

Section: Safety Of Sa and Camentioning

confidence: 84%

“…Initial efficacy of this minimally invasive surgery has been reported to be Ͼ90% in selected populations. [11][12][13][14][15] With 2 invasive percutaneous options available, there is growing debate on the relative position of CA and SA, although no direct comparative trials have been performed. In the 2010 European Society of Cardiology guidelines, 2 CA in AF patients refractory to AAD has received a Class 2A or 2B (Level of Evidence A/C) indication, depending on paroxysmal or (longstanding) persistent AF, whereas SA has a Class 2B (Level of Evidence C) indication only after failure of CA.…”

Section: Clinical Perspective On P 30mentioning

confidence: 99%

See 2 more Smart Citations

Atrial Fibrillation Catheter Ablation Versus Surgical Ablation Treatment (FAST)

et al. 2012

Self Cite

View full text Add to dashboard Cite

Background-Catheter ablation (CA) and minimally invasive surgical ablation (SA) have become accepted therapy for antiarrhythmic drug-refractory atrial fibrillation. This study describes the first randomized clinical trial comparing their efficacy and safety during a 12-month follow-up. Methods and Results-One hundred twenty-four patients with antiarrhythmic drug-refractory atrial fibrillation with left atrial dilatation and hypertension (42 patients, 33%) or failed prior CA (82 patients, 67%) were randomized to CA (63 patients) or SA (61 patients). CA consisted of linear antral pulmonary vein isolation and optional additional lines. SA consisted of bipolar radiofrequency isolation of the bilateral pulmonary vein, ganglionated plexi ablation, and left atrial appendage excision with optional additional lines. Follow-up at 6 and 12 months was performed by ECG and 7-day Holter recording. The primary end point, freedom from left atrial arrhythmia Ͼ30 seconds without antiarrhythmic drugs after 12 months, was 36.5% for CA and 65.6% for SA (Pϭ0.0022). There was no difference in effect for subgroups, which was consistent at both sites. The primary safety end point of significant adverse events during the 12-month follow-up was significantly higher for SA than for CA (nϭ21 [34.4%] versus nϭ10 [15.9%]; Pϭ0.027), driven mainly by procedural complications such as pneumothorax, major bleeding, and the need for pacemaker. In the CA group, 1 patient died at 1 month of subarachnoid hemorrhage. Conclusion-In atrial fibrillation patients with dilated left atrium and hypertension or failed prior atrial fibrillation CA, SA is superior to CA in achieving freedom from left atrial arrhythmias after 12 months of follow-up, although the procedural adverse event rate is significantly higher for SA than for CA. Clinical Trial Registration-URL: http://clinicaltrials.gov. Unique identifier: NCT00662701.

show abstract

Section: Discussionmentioning

confidence: 87%

Section: Safety Of Sa and Camentioning

confidence: 84%

Section: Clinical Perspective On P 30mentioning

confidence: 99%

See 1 more Smart Citation

Atrial Fibrillation Catheter Ablation Versus Surgical Ablation Treatment (FAST)

et al. 2012

Self Cite

View full text Add to dashboard Cite

show abstract

“…Surgery was started on the patient's right side with 10-mm ports; 2 ports in the fourth and sixth intercostal space midaxillary line, and 1 port in the third or fourth intercostal space anterior axillary line. GPs were localized as described previously 10 with highfrequency stimulation (18 V, 1-ms pulse width, 1000 Hz) on the anterior right GP and inferior right GP. High-frequency pacing was delivered through an Atricure Cooltip (Atricure Inc, Cincinnati, OH) ablation pen positioned on the fat pad containing the GP and connected to an external pacemaker device, Oscor Pace 203H DDD External Dual-Chamber Pacemaker (Oscor Inc, Palm Harbor, FL).…”

Section: Surgical Techniquementioning

confidence: 99%

Thoracoscopic Video-Assisted Pulmonary Vein Antrum Isolation, Ganglionated Plexus Ablation, and Periprocedural Confirmation of Ablation Lesions

Gründeman

Driessen

Boven

et al. 2011

Circ: Arrhythmia and Electrophysiology

Self Cite

174

169

View full text Add to dashboard Cite

Background-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. Methods and Results-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 ablation lines. After 1 year, 19 of 22 patients (86%) had no recurrences of AF, atrial flutter, or atrial tachycardia and were not using antiarrhythmic drugs (11/12 paroxysmal, 7/9 persistent, and 1/1 long-standing persistent). Three patients had a sternotomy because of uncontrolled bleeding during thoracoscopic surgery. Four adverse events were 1 hemothorax, 1 pneumothorax, and 2 pneumonia. No thromboembolic complications or mortality occurred. Conclusions-Thoracoscopic surgery with PVI and ganglionated plexus ablation for AF is a safe and successful procedure with a single procedure success rate of 86% at 1 year. Electrophysiological guided thorough PVI and additional left atrial ablation line creation presumably contributes in achieving a high success rate in the surgical treatment of AF. (Circ Arrhythm Electrophysiol. 2011;4:262-270.)

show abstract

“…A minimally-invasive procedure via bilateral minithoracotomies for paroxysmal AF is associated with 80.8% freedom from AF at 1 year (37). Thoracoscopic bilateral PVI and LAA exclusion has also been described for treatment of lone AF refractory to cathether ablation (38,39). For patients with concomitant, paroxysmal AF, PVI may be performed using a bipolar RF device to create two lesions separately encircling left and right pulmonary veins for patients undergoing MV repair or replacement, AVR or CABG.…”

Section: Pulmonary Vein Isolationmentioning

confidence: 99%