Total thoracoscopic ablation in patients with atrial fibrillation and left ventricular dysfunction

Abstract

Objective: To evaluate the effectiveness and safety of totally thoracoscopic ablation (TTA) in patients with left ventricular (LV) dysfunction for treatment of atrial fibrillation (AF) refractory to antiarrhythmic drug (AAD) therapy.Methods: Between January 2012 and December 2018, 31 patients underwent TTA with drug-refractory AF and preoperative left ventricular ejection fraction (LVEF) <50% were included. Of the 31 patients, 8 received additional catheter ablation with an electrophysiologic study within 3 months after TTA. The rhythm outcome was obtained by 12-lead electrocardiography or 24-hour Holter monitoring. Results:The patient cohort had a mean age of 54.9 AE 9.0 years and consisted of 51.6% with persistent AF (n ¼ 16), 45.2% with long-standing persistent AF (n ¼ 14), and 3.2% with paroxysmal AF (n ¼ 1). No patients died during the follow-up period. Compared with baseline, mean postoperative LVEF at 3 months (interquartile range [IQR], 2-6 months) increased significantly (from 39.7 AE 6.1% to 53.6 AE 9.3%; P < .001). At 25 months (IQR, 14-45 months), LVEF was sustained or further improved (from 39.7 AE 6.1% to 58.1 AE 7.5%; P < .001). The rate of sinus rhythm state was 93.5% (29 of 31), and freedom from arrhythmias off AADs after the final procedure was 61.3% (19 of 31) at a median follow-up of 32 months (IQR, 24-54 months).

Xuesaitong promotes myocardial angiogenesis in myocardial infarction mice by inhibiting MiR-3158-3p targeting Nur77

“…In the meantime, the thinning of the ventricular wall may influence the left ventricular EF (%). EF is the main index for evaluating the left ventricular systolic function, which can reflect the myocardial fiber shortening function of the left ventricle [ 17 ]. The results also demonstrated that the EF of the left ventricle of mice in Model group was remarkably raised after high-dose XST treatment, further suggesting that high-dose XST can relieve cardiac hypofunction after myocardial infarction in mice.…”

Hybrid Ablation of Nonparoxysmal Atrial Fibrillation: The Convergent and Totally Thoracoscopic Approaches

“…Attempts to restore normal sinus rhythm with repeat catheter ablations ranges from 1% [ 34 ] to 20% [ 27 ]. Although depressed EF has not been described as a predictor of recurrence and despite RCTs (CASTLE-AF [ 35 ], CAMERA-MRI [ 36 ]) that demonstrate the promise of catheter ablation in a depressed LVEF population, only a single published series with a TT Maze Hybrid approach in depressed EF patients is reported and it also reveals significant improvement in LVEF% with 61% HRS success at 32-month follow-up [ 37 ].…”