Thoracoscopic epicardial ablation of the left and right atrium. Beating heart procedure in patients with atrial fibrillation

Bartuś, Krzysztof; Kiser, Andy C.; Majewski, Jacek; Kapelak, Bogusław; Konstanty-Kalandyk, Janusz; Lelakowski, Jacek; Bednarek, Jacek; Bartuś, Stanisław; Wierzbicki, Karol; Sobczyński, Robert; Sadowski, Jerzy

doi:10.20452/pamw.1216

Cited by 3 publications

(1 citation statement)

References 8 publications

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“…Few studies have reported the results of thoracoscopic surgical biatrial ablation for patients with PerAF [11,12]. Furthermore, to our knowledge, there is no study comparing surgical biatrial ablation with CA for the treatment of PerAF so far.…”

Section: Introductionmentioning

confidence: 99%

Thoracoscopic Surgical Biatrial Ablation vs. Catheter Ablation in Patients with Persistent Atrial Fibrillation

Yu,

Li,

Yuan

et al. 2023

Journal of Cardiac Surgery

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Background. Limited randomized controlled studies showed that thoracoscopic surgical left atrial ablation was not superior to catheter ablation (CA) in patients with persistent atrial fibrillation (PerAF). Right atrium might play an important role in triggering and maintaining atrial fibrillation (AF) in patients with PerAF. This study aimed to compare the efficacy of thoracoscopic surgical biatrial ablation versus CA in patients with PerAF. Methods. Patients with PerAF underwent thoracoscopic surgical biatrial ablation or CA were included in this study. Propensity score matching (1 : 2) was applied to select patients in CA group and surgical ablation (SA) group. The primary endpoint was to compare the probability of freedom from atrial tachyarrhythmias between SA and CA. Atrial tachyarrhythmia recurrence was defined as any atrial tachyarrhythmias longer than 30 s documented by 24-hour Holter monitoring after the 3-month blanking period. Results. After propensity score matching, 51 patients in surgical biatrial ablation group and 102 patients in CA group were enrolled (mean left atrial diameter: 45.8 mm). The probability of freedom from atrial tachyarrhythmias on antiarrhythmia drugs was 62.7%, 60.6%, and 60.6% in SA group and 42.0%, 39.6%, and 36.7% in CA group at 12, 24, and 36 months, respectively ( p = 0.011), and off antiarrhythmia drugs were 56.9%, 52.5%, and 52.5% in SA group and 36.0%, 31.4%, and 27.5% in CA group at 12, 24, and 36 months, respectively ( p = 0.007). After adjustment of age, sex, left atrial diameter, and AF duration history, multivariable Cox regression analysis suggested that SA procedure was an independent factor to reduce the risk of atrial tachyarrhythmia recurrence (HR: 0.589, 95% CI 0.370–0.937, p = 0.025). Conclusion. Compared with CA, thoracoscopic surgical biatrial ablation might achieve superior effectiveness for patients with PerAF.

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Section: Introductionmentioning

confidence: 99%

Thoracoscopic Surgical Biatrial Ablation vs. Catheter Ablation in Patients with Persistent Atrial Fibrillation

Yu,

Li,

Yuan

et al. 2023

Journal of Cardiac Surgery

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Box lesion or bi-atrial lesion set for atrial fibrillation during thoracoscopic epicardial ablation

Zheng

Liu

et al. 2021

Interactive CardioVascular and Thoracic Surgery

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OBJECTIVES Thoracoscopic epicardial ablation with a limited lesion set led to suboptimal results for advanced paroxysmal atrial fibrillation (AF) or persistent AF. Whether additional right atrial lesions improve the result is unclear. METHODS We conducted a retrospective study involving 80 consecutive patients with paroxysmal or persistent AF, left atrial (LA) dilation (LA diameter >40 mm) and failed prior interventional ablation (40 patients, 50%) who underwent thoracoscopic epicardial ablation with box lesions (36 patients) or bi-atrial (BA) lesion (44 patients) in our institution. Freedom from atrial tachyarrhythmias after the procedures was compared between the box lesion group and BA lesion group. RESULTS Baseline differences included more patients with persistent AF (86.4% vs 47.2%) and larger left atrium [48.00 (44.00–50.75) vs 42.00 (41.25–44.00) mm] in the BA lesion group. There was no difference in procedural complications between the 2 groups. After a mean follow-up of 32 months, the freedom from atrial tachyarrhythmias off antiarrhythmic drugs at 6, 12 and 24 months was 77.2%, 77.2% and 77.2% in the BA lesion group and 69.4%, 50.0% and 40.6% in the box lesion group, respectively (P = 0.006). After adjustment for sex, age, body mass index, LA diameter, AF type, history of AF, and previous interventional ablation, BA lesion was an independent predictor of lower atrial tachyarrhythmia recurrence (hazard ratio 0.447, 95% confidential interval 0.208–0.963; P = 0.040). CONCLUSIONS Compared with the box lesion set, thoracoscopic epicardial ablation with BA lesion sets might provide better freedom from atrial tachyarrhythmias for paroxysmal or persistent AF with LA dilation. Randomized control trials are warranted to confirm the benefit of BA lesion sets in these patients.

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Left atrial appendage occlusion procedures

Bartuś

2017

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Thoracoscopic epicardial ablation of the left and right atrium. Beating heart procedure in patients with atrial fibrillation

Cited by 3 publications

References 8 publications

Thoracoscopic Surgical Biatrial Ablation vs. Catheter Ablation in Patients with Persistent Atrial Fibrillation

Thoracoscopic Surgical Biatrial Ablation vs. Catheter Ablation in Patients with Persistent Atrial Fibrillation

Box lesion or bi-atrial lesion set for atrial fibrillation during thoracoscopic epicardial ablation

Left atrial appendage occlusion procedures

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