Expert consensus guidelines: Examining surgical ablation for atrial fibrillation

Ad, Niv; Damiano, Ralph J.; Badhwar, Vinay; Calkins, Hugh; Meir, Mark La; Nitta, Takashi; Doll, Nicolas; Holmes, Sari D.; Weinstein, Ali A.; Gillinov, Marc

doi:10.1016/j.jtcvs.2017.02.027

Cited by 152 publications

(173 citation statements)

References 99 publications

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“…According to recent studies [25] , the most appropriate devices for beating heart PV isolation are bipolar radiofrequency clamps, but testing for exit or entrance block is mandatory. Surface bipolar radiofrequency devices may be recommended for free wall linear ablation when lesion integrity can be tested, however multiple applications are recommended to achieve adequate lesion depth, which requires additional time.…”

Section: Resultsmentioning

confidence: 99%

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Thoracoscopic Pulmonary Vein and Left Atrial Posterior Wall Isolation Combined with Left Atrial Appendage Resection in Patients with Long-Standing Persistent Atrial Fibrillation

Zotov¹,

Vachev²,

Borisov³

et al. 2020

Braz J Cardiovasc Surg

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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.

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Section: Resultsmentioning

confidence: 99%

“…Additionally, the modified technique shows promising medium-term results (all patients were in sinus rhythm 180 days after the surgery), taking into account that all patients had a long history of persistent AF before the procedure (median: 23 [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] months).…”

Section: Resultsmentioning

confidence: 99%

Thoracoscopic Pulmonary Vein and Left Atrial Posterior Wall Isolation Combined with Left Atrial Appendage Resection in Patients with Long-Standing Persistent Atrial Fibrillation

Zotov¹,

Vachev²,

Borisov³

et al. 2020

Braz J Cardiovasc Surg

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“…The Tiger Paw System (Maquet Medical Systems, Getinge, Sweden), which enabled epicardial closure at the bottom of the LAA with a soft silicone clamp, was withdrawn from the market by the U.S. Food and Drug Administration [27] due to possible safety issues. Most of these procedures are performed concomitantly during open chest cardiac surgery but can also be performed epicardially during thoracoscopic AF ablation or as a pure stand-alone procedure, either minimally invasive (minithoracotomy) or thoracoscopically [28][29][30][31].…”

Section: Surgical Treatment Options For the Left Atrial Appendagementioning

confidence: 99%

Surgical management of the left atrial appendage: a must or a myth?

Hanke

2018

European Journal of Cardio-Thoracic Surgery

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Surgical treatment of the left atrial appendage (LAA) has increased over the past few years. The most serious complication of atrial fibrillation is a cerebral cardioembolic stroke. In most patients with atrial fibrillation, the LAA is the anatomical source of the embolism. Several surgical techniques for occluding the LAA using different devices have been developed with different prospects of success. It is still not clear which of these techniques represents the optimum treatment for reducing the incidence of stroke in patients with atrial fibrillation. This text focuses on the surgical closure of LAA and critically considers the results with respect to closure success and the associated complications.

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“…Current guidelines for surgical ablation of atrial fibrillation (AF) have re‐affirmed the safety and relative efficacy of the maze procedure in both stand‐alone and concomitant settings . Furthermore, these guidelines encourage ongoing postablation rhythm monitoring.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of new generation loop recorders placed during surgical ablation for atrial fibrillation

DeBoard

Doty

2018

J Card Surg

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Expert consensus guidelines: Examining surgical ablation for atrial fibrillation

Cited by 152 publications

References 99 publications

Thoracoscopic Pulmonary Vein and Left Atrial Posterior Wall Isolation Combined with Left Atrial Appendage Resection in Patients with Long-Standing Persistent Atrial Fibrillation

Thoracoscopic Pulmonary Vein and Left Atrial Posterior Wall Isolation Combined with Left Atrial Appendage Resection in Patients with Long-Standing Persistent Atrial Fibrillation

Surgical management of the left atrial appendage: a must or a myth?

Evaluation of new generation loop recorders placed during surgical ablation for atrial fibrillation

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