Immediate electrophysiological characteristics following modified thoracoscopic ablation via unilateral approach for non-valvular atrial fibrillation

Abstract

Background Thoracoscopic ablation has emerged as an effective therapy for patients with long-standing persistent Atrial fibrillation (LsPAF). We aimed to investigate the immediate electrophysiological characteristics following modified ablation with 3 circular and 3 linear lesions in the thoracoscopic procedure via a unilateral approach. Methods Between May 2015 and October 2018, 40 patients underwent the one-stage hybrid procedure for LsPAF. Isolation of the pulmonary veins (PV) and left atrium posterior wall (LAPW), excision of the left atrial appendage (LAA), and high-density endocardial mapping and individualized percutaneous catheter ablation for AF termination were performed. Results The modified thoracoscopic procedure may enable successful PV and LAPW isolation and LAA removal. Endocardial electrophysiological examination showed 6 out of 40 (15%) patients with a right PV gap, 3 (7.5%) patients with incomplete roof lesions, and 8 (20%) patients with incomplete Dallas lesions. A total of 44 driving areas were mapped and ablated. Thirty-five patients achieved procedural AF termination. After a mean follow-up period of 26 months, the success rate of a single procedure was 85%. Cox regression analysis demonstrated that the failure of procedural AF termination may be a risk factor in atrial tachyarrhythmia recurrence. Discussion Endocardial electrophysiological examination is a necessary partner to thoracoscopic ablation. Our modified thoracoscopic ablation and driving areas-based ablation contribute to high rates of procedural AF termination, which may lead to reduced recurrence rate. The hybrid procedure may be an effective strategy for the management of LsPAF.

Mid term freedom from atrial fibrillation following hybrid ablation, a systematic review and meta analysis

“…The convergent procedure was performed in four studies via a subxiphoid laparoscopic approach [ 20 , 21 , 23 , 25 ]. Surgical Left atrial appendage (LAA) exclusion was variably performed, performed across all patients in 6 studies [ 18 – 20 , 24 , 28 , 31 ]. Ganglionated plexus (GP) ablations were performed in 7 studies [ 17 – 19 , 22 , 24 , 28 , 31 ].…”

“…Surgical Left atrial appendage (LAA) exclusion was variably performed, performed across all patients in 6 studies [ 18 – 20 , 24 , 28 , 31 ]. Ganglionated plexus (GP) ablations were performed in 7 studies [ 17 – 19 , 22 , 24 , 28 , 31 ]. Ligament of Marshall ligations were performed in 8 studies (with one study performing it in 67 of 72 patients) [ 17 – 19 , 22 , 24 , 28 , 30 , 31 ].…”

“…Ganglionated plexus (GP) ablations were performed in 7 studies [ 17 – 19 , 22 , 24 , 28 , 31 ]. Ligament of Marshall ligations were performed in 8 studies (with one study performing it in 67 of 72 patients) [ 17 – 19 , 22 , 24 , 28 , 30 , 31 ]. These results are summarised in Additional file 1 : Table S2.…”

Comparison of short-term efficacy of two bipolar radiofrequency ablation forceps for rheumatic heart disease concomitant with atrial fibrillation

“…Nowadays, surgical ablation of AF is developing in the direction of being non-beating and minimally invasive. Mei's minimally invasive ablation technique created by Prof. Meiju in China utilizes TV thoracoscopy to ablate AF in a non-beating heart through a self-designed ablation line, which improves the success rate of the operation and reduces the occurrence of postoperative complications ( 33 ). Recently, given the close collaboration between cardiac surgeons and electrophysiologists, a one-stop sequential ablation strategy based on surgical/catheter ablation has been introduced with good results in patients with persistent AF.…”

Effectiveness of Maze IV procedure versus thoracoscopic ablation for atrial fibrillation: a propensity score-matched analysis

“…Second, in CMP-IV, ablation lines are completed entirely using ablation clamps, ensuring ablation quality. In contrast, in TA, some ablation lines can only be made using ablation pens, resulting in lower ablation quality than that of ablation clamps ( 12 , 13 ). Third, due to anatomical constraints, the mitral valve isthmus cannot be ablated from the epicardium, and only the Dallas line is feasible.…”