Thoracoscopic Left Atrial Appendage Clipping

Laar, Charlotte van; Verberkmoes, Niels; Es, Hendrik W. van; Lewalter, Thorsten; Dunnington, Gan; Stark, Stephen; Longoria, James; Hofman, Frederik H.; Pierce, Carolyn M.; Kotecha, Dipak; Putte, Bart P. van

doi:10.1016/j.jacep.2018.03.009

Cited by 60 publications

(57 citation statements)

References 34 publications

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“…The incidence of complications is highly variable within the surgical literature, for example the rate of conversion to sternotomy following bleeding varies from 0% to 10% 7 , 13 , 16 , 23–25 . Comparing composite complication rates is made even more challenging by variable definitions of major and minor complications.…”

Section: Discussionmentioning

confidence: 99%

Early experience of thoracoscopic vs. catheter ablation for atrial fibrillation

et al. 2019

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Aims Video-assisted thoracoscopic surgery (VATS) ablation has been advocated as a treatment option for non-paroxysmal atrial fibrillation (AF) in recent guidelines. Real-life data on its safety and efficacy during a centre’s early experience are sparse. Methods and results Thirty patients (28 persistent/longstanding persistent AF) underwent standalone VATS ablation for AF by an experienced thoracoscopic surgeon, with the first 20 cases proctored by external surgeons. Procedural and follow-up outcomes were collected prospectively, and compared with 90 propensity-matched patients undergoing contemporaneous catheter ablation (CA). Six (20.0%) patients undergoing VATS ablation experienced ≥1 major complication (death n = 1, stroke n = 2, conversion to sternotomy n = 3, and phrenic nerve injury n = 2). This was significantly higher than the 1.1% major complication rate (tamponade requiring drainage n = 1) seen with CA ( P < 0.001). Twelve-month single procedure arrhythmia-free survival rates without antiarrhythmic drugs were 56% in the VATS and 57% in the CA cohorts ( P = 0.22), and 78% and 80%, respectively given an additional CA and antiarrhythmic drugs ( P = 0.32). Conclusion During a centre’s early experience, VATS ablation may have similar success rates to those from an established CA service, but carry a greater risk of major complications. Those embarking on a programme of VATS AF ablation should be aware that complication and success rates may differ from those reported by selected high-volume centres.

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Section: Discussionmentioning

confidence: 99%

Early experience of thoracoscopic vs. catheter ablation for atrial fibrillation

et al. 2019

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“…Like other interventional procedures, there is evidence of a learning curve with thoracoscopic ablation, and also that complications can be reduced in expert hands to a similar level as seen with percutaneous approaches 18 . If this trend continues, along with better technologies and patient selection, there may be a wider role for thoracoscopic procedures in the future 19 . Although recently presented data did not identify a clinical advantage from catheter ablation over drug therapy, 20 further study data are awaited to establish if early control of rhythm can lead to improved prognosis for patients with AF.…”

Section: Discussionmentioning

confidence: 99%

Thoracoscopic vs. catheter ablation for atrial fibrillation: long-term follow-up of the FAST randomized trial

et al. 2019

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Aims Our objectives were to compare effectiveness and long-term prognosis after epicardial thoracoscopic atrial fibrillation (AF) ablation vs. endocardial catheter ablation, in patients with prior failed catheter ablation or high risk of failure. Methods and results Patients were randomized to thoracoscopic or catheter ablation, consisting of pulmonary vein isolation with optional additional lines (2007–2010). Patients were reassessed in 2016/2017, and those without documented AF recurrence underwent 7-day ambulatory electrocardiography. The primary rhythm outcome was recurrence of any atrial arrhythmia lasting >30 s. The primary clinical endpoint was a composite of death, myocardial infarction, or cerebrovascular event, analysed with adjusted Cox proportional hazard ratios (HRs). One hundred and 24 patients were randomized with 34% persistent AF and mean age 56 years. Arrhythmia recurrence was common at mean follow-up of 7.0 years, but substantially lower with thoracoscopic ablation: 34/61 (56%) compared with 55/63 (87%) with catheter ablation [adjusted HR 0.40, 95% confidence interval (CI) 0.25–0.64; P < 0.001]. Additional ablation procedures were performed in 8 patients (13%) compared with 31 (49%), respectively ( P < 0.001). Eleven patients (19%) were on anti-arrhythmic drugs at end of follow-up with thoracoscopy vs. 24 (39%) with catheter ablation ( P = 0.012). There was no difference in the composite clinical outcome: 9 patients (15%) in the thoracoscopy arm vs. 10 patients (16%) with catheter ablation (HR 1.11, 95% CI 0.40–3.10; P = 0.84). Pacemaker implantation was required in 6 patients (10%) undergoing thoracoscopy and 3 (5%) in the catheter group ( P = 0.27). Conclusion Thoracoscopic AF ablation demonstrated more consistent maintenance of sinus rhythm than catheter ablation, with similar long-term clinical event rates.

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“…[ 62 – 65 ] Acute and long-term closure rates have been >95% with residual stumps >10 mm in only 0–5% of cases. [ 62 , 63 ] The AtriClip began to be placed through a left thoracoscopic approach in 2012, and convergent procedures began incorporating the AtriClip in 2017 ( Figure 4 ). [ 66 – 69 ] As the convergent procedure already enlists the assistance of the surgeon, the thoracoscopic addition of the AtriClip is able to be performed in the same procedure setting in a cost-effective manner.…”

Section: Concomitant Laa Exclusion Using the Atriclipmentioning

confidence: 99%

The Convergent Atrial Fibrillation Ablation Procedure: Evolution of a Multidisciplinary Approach to Atrial Fibrillation Management

Wats¹,

Kiser²,

Makati³

et al. 2020

Arrhythmia &Amp; Electrophysiology Review

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The treatment of AF has evolved over the past decade with increasing use of catheter ablation in patients refractory to medical therapy. While pulmonary vein isolation using endocardial catheter ablation has been successful in paroxysmal AF, the results have been more controversial in patients with long-standing persistent AF where extrapulmonary venous foci are increasingly recognised in the initiation and maintenance of AF. Hybrid ablation is the integration of minimally invasive epicardial ablation with endocardial catheter ablation, and has been increasingly used in this population with better results. The aim of this article was to analyse and discuss the evidence for the integration of catheter and minimally invasive surgical approaches to treat AF with specific focus on convergent ablation and exclusion of the left atrial appendage using a surgically applied clip.

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Thoracoscopic Left Atrial Appendage Clipping

Cited by 60 publications

References 34 publications

Early experience of thoracoscopic vs. catheter ablation for atrial fibrillation

Early experience of thoracoscopic vs. catheter ablation for atrial fibrillation

Thoracoscopic vs. catheter ablation for atrial fibrillation: long-term follow-up of the FAST randomized trial

The Convergent Atrial Fibrillation Ablation Procedure: Evolution of a Multidisciplinary Approach to Atrial Fibrillation Management

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