Feasibility and outcome of epicardial pulmonary vein isolation for lone atrial fibrillation using minimal invasive surgery and high intensity focused ultrasound

Klinkenberg, Theo J.; Ahmed, Sheba; Hagen, Anita ten; Wiesfeld, Ans C.P.; Tan, Eng S.; Zijlstra, Felix; Gelder, Isabelle C. Van

doi:10.1093/europace/eup299

Cited by 39 publications

(35 citation statements)

References 28 publications

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“…Although our population included higher proportions of patients with persistent atrial fibrillation, previous failed catheter ablations, and daily ECG monitoring, our results are comparable, in terms of freedom from any atrial arrhythmia, to those reported in previous studies with even less strict success definitions [9, 13, 15]. We decided not to consider the first 3 months as a blanking period because we have noted that early recurrences are predictive of later recurrences in the follow-up period, as already reported by other authors [14].…”

Section: Discussionsupporting

confidence: 81%

Feasibility and efficacy of minimally invasive stand-alone surgical ablation of atrial fibrillation. A single-center experience

Santini

Loiaconi

Tocco

et al. 2012

J Interv Card Electrophysiol

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PurposeMinimally invasive surgical ablation for atrial fibrillation (AF) has shown good results and low complications incidence. Our objective was to evaluate feasibility and efficacy of this technique in our center.MethodsThe procedure included pulmonary vein isolation, ganglionic plexi ablation, ligament of Marshall resection, and left atrial appendage exclusion through beating heart minimally invasive bilateral thoracotomies. Patients were monitored daily by telemedicine during the first 4 months and then by quarterly 24-h Holter monitoring or by implantable cardiac monitor. Ablation success was defined as freedom from any atrial tachyarrhythmia recurrence lasting more than 30 s and from antiarrhythmic drugs. All patients were followed up for a minimum of 12 months.ResultsTwenty-two consecutive patients with AF, paroxysmal in 27% and persistent in 73%, were treated. Mean age was 63 ± 10 years, 86% were men. Seventy-three percent of patients had previously undergone to one or more catheter ablations. Median follow-up period was 22 months (25°–75° percentile, 20–27). Patients free from any arrhythmia recurrence for at least 6 consecutive months discontinued antiarrhythmic therapy. Ablation was successful in 73% of patients at 12 months. Freedom from AF recurrences independently from antiarrhythmic therapy status was 91% at 12 months. Results were consistent in patients that reached 24 months follow-up. There were no deaths. Complications were: one conversion to sternotomy owing to thoracic adherences, one pacemaker implant, and one postoperative hemothorax requiring surgical revision.ConclusionsOur results show that minimally invasive surgical ablation was feasible and gave satisfactory results at long-term term follow-up in patients with AF.

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Section: Discussionsupporting

confidence: 81%

Feasibility and efficacy of minimally invasive stand-alone surgical ablation of atrial fibrillation. A single-center experience

Santini

Loiaconi

Tocco

et al. 2012

J Interv Card Electrophysiol

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“…High-intensity focused ultrasound (HIFU) ablation is an emerging therapeutic modality that has been applied in a variety of clinical contexts (Crouzet et al 2010; Illing et al 2005; Kennedy 2005; ter Haar 2007; ter Haar 2008; Vaezy and Zderic 2007; Wu et al 2005), including ablation of cardiac tissue for treatment of cardiac arrhythmia (Groh et al 2008; Groh et al 2007; Klinkenberg et al 2009; Mitnovetski et al 2009; Natale et al 2000; Ninet et al 2005; Saliba et al 2002; Schopka et al 2010). While other methods, such as radiofrequency (RF) electrical ablation, cryoablation, and laser ablation, have been employed clinically (Lall and Damiano 2007), these methods either directly contact tissue or have limited penetration depth and thus ablate mainly by thermal conduction.…”

Section: Introductionmentioning

confidence: 99%

High-Frequency Ultrasound M-Mode Imaging for Identifying Lesion and Bubble Activity During High-Intensity Focused Ultrasound Ablation

Kumon¹,

Gudur²,

Zhou³

et al. 2012

Ultrasound in Medicine & Biology

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Effective real-time monitoring of high-intensity focused ultrasound (HIFU) ablation is important for application of HIFU technology in interventional electrophysiology. This study investigated rapid, high-frequency M-mode ultrasound imaging for monitoring spatiotemporal changes during HIFU application. HIFU (4.33 MHz, 1 kHz PRF, 50% duty cycle, 1 s, 2600 – 6100 W/cm2) was applied to ex-vivo porcine cardiac tissue specimens with a confocally and perpendicularly aligned high-frequency imaging system (Visualsonics Vevo 770, 55 MHz center frequency). Radiofrequency (RF) data from M-mode imaging (1 kHz PRF, 2 s × 7 mm) was acquired before, during, and after HIFU treatment (n = 12). Among several strategies, the temporal maximum integrated backscatter with a threshold of +12 dB change showed the best results for identifying final lesion width (receiver-operating characteristic curve area 0.91 ± 0.04, accuracy 85 ± 8%, as compared to macroscopic images of lesions). A criterion based on a line-to-line decorrelation coefficient is proposed for identification of transient gas bodies.

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“…Endocardial radiofrequency reablation was required in 40% of the patients, and two major complications occurred, including one case of late tamponade and one case of bleeding during surgery. 34 In addition, laser can be an effective tool for endocardial ablation, in terms of effectiveness of isolation and transmural effects, as shown in a sheep model. 35 Bisleri et al 16 did not observe any complications relating to bipolar radiofrequency use in six patients with off-pump video-assisted PVI, and all six patients achieved a sinus rhythm within the six-month observation period.…”

Section: Off-pump Maze Proceduresmentioning

confidence: 99%

Surgical treatment of lone atrial fibrillation

2010

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Currently, off-pump video-assisted thoracoscopic epicardial pulmonary vein isolation offers an attractive alternative to on-pump Maze procedures for surgical treatment of lone atrial fibrillation. Nevertheless, on-pump Maze procedures through a mid-sternotomy approach still play an important role in patients with lone atrial fibrillation on many occasions, especially in patients with failed percutaneous pulmonary vein alone. The aim of this article was to give a brief review of the surgical strategies for treating lone atrial fibrillation, and present the possible indications for on-pump Maze procedures through a mid-sternotomy approach. RESUMOAtualmente, isolamento epicárdico da veia pulmonar com cirurgia torácica vídeo-assistida sem circulação extracorpórea oferece uma alternativa atraente para procedimento de Maze com circulação extracorpórea no tratamento cirúrgico da fibrilação atrial solitária. No entanto, procedimento de Maze com circulação extracorpórea através de uma meio-esternotomia ainda desempenha papel importante em pacientes com fibrilação atrial isolada em várias ocasiões, especialmente em pacientes com falha da veia pulmonar percutânea isoladamente. O objetivo do artigo é fazer uma breve revisão de estratégias para o tratamento cirúrgico fibrilação atrial isolado e apresentar as possíveis indicações de procedimento de Maze com extracorpórea, através de uma abordagem meio-esternotomia.

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Feasibility and outcome of epicardial pulmonary vein isolation for lone atrial fibrillation using minimal invasive surgery and high intensity focused ultrasound

Cited by 39 publications

References 28 publications

Feasibility and efficacy of minimally invasive stand-alone surgical ablation of atrial fibrillation. A single-center experience

Feasibility and efficacy of minimally invasive stand-alone surgical ablation of atrial fibrillation. A single-center experience

High-Frequency Ultrasound M-Mode Imaging for Identifying Lesion and Bubble Activity During High-Intensity Focused Ultrasound Ablation

Surgical treatment of lone atrial fibrillation

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