Totally Endoscopic Ablation of Lone Atrial Fibrillation: Initial Clinical Experience

Pruitt, J. Crayton; Lazzara, Robert R.; Dworkin, Gary H.; Badhwar, Vinay; Kuma, Carol; Ebra, George

doi:10.1016/j.athoracsur.2005.07.095

Cited by 97 publications

(53 citation statements)

References 20 publications

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“…Pulmonary vein isolation and excision of the left atrial appendage can be performed with the use of a minimally invasive "keyhole approach" or thoracoscopically; neither approach requires cardiopulmonary bypass. 43,44 These minimally invasive procedures enable wide, circumferential pulmonary vein isolation, either with a single "box" lesion or separate oval-shaped ablations on the right and left. Procedure times are generally 2 to 4 hours, and median length of hospital stay is 3 days.…”

Section: Current Indications and Strategies For Surgical Af Ablationmentioning

confidence: 99%

Advances in Surgical Treatment of Atrial Fibrillation

Gillinov

2007

Stroke

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Abstract-Atrial fibrillation (AF) is the most common sustained arrhythmia. It is associated with increased risks of death and stroke; most strokes in AF patients are thought to arise from thrombi in the left atrial appendage. Surgical ablation of AF includes excision of the left atrial appendage and is an effective means of treating this arrhythmia, with the classic Maze procedure curing AF in Ͼ90% of patients and virtually eliminating the risk of late stroke. A complex but safe operation, the Maze procedure has been applied by relatively few surgeons. Americans; this number is expected to increase to Ͼ5.6 million by 2050. 1 The prevalence of AF increases with increasing patient age, and recent data from the Framingham Heart Study suggest that the lifetime risks for development of AF are 1 in 4 for men and women aged Ն40 years. 2 This epidemic has a growing impact on the healthcare system and a multibillion dollar cost. The clinical consequences of AF are well documented. AF is associated with reduced life expectancy and increases the risk of stroke 5-fold, accounting for Ϸ15% of all strokes nationally. 3-8 These AF-related strokes are a major challenge and a focus of several clinical trials investigating strategies for primary and secondary prevention. 4 Currently, antithrombotic therapy is the mainstay for stroke prevention in AF patients.Although there is currently some consensus concerning pharmacological strategies for stroke prevention in AF patients, choice of therapy for the heart rhythm is controversial and evolving. 9,10 Available antiarrhythmic therapies inconsistently restore sinus rhythm and are associated with complications. In fact, the risks associated with antiarrhythmic drug therapy may counterbalance the potential benefit of restoration of sinus rhythm. 9,10 These observations, coupled with increased understanding of the pathogenesis of AF, have resulted in the development of interventional strategies to restore sinus rhythm. Both catheter-based and surgical approaches have demonstrated effectiveness in this regard. Developed by Dr James Cox, the classic Maze procedure is the predicate operation for ablation of AF; long-term data suggest that the Maze procedure eliminates AF in Ͼ90% of patients. 11-14 Despite these unmatched results, the complexity and time associated with the Maze procedure have prevented widespread application by surgeons.Recently, however, there has been increased interest in direct surgical ablation of AF, fueled by technological advances and demonstration that the pulmonary veins and left atrium are the drivers of AF in most patients. 15 New ablation technologies enable surgeons to perform pulmonary vein isolation, create strategically placed, linear left atrial lesions, and excise the left atrial appendage rapidly and safely. 16 -23 Alternate energy sources used to create lines of conduction block and replace surgical incisions of the Maze procedure include radiofrequency, microwave, ultrasound, cryothermy, and laser. 16 -25 Applied primarily in patients with valvular...

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Section: Current Indications and Strategies For Surgical Af Ablationmentioning

confidence: 99%

Advances in Surgical Treatment of Atrial Fibrillation

Gillinov

2007

Stroke

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“…As a result, since Saltman et al 9 first reported a thoracoscopic approach to microwave ablation for AF in 2003, minimally invasive techniques using thoracoscopy and robotic surgery have become possible and widespread throughout Western countries. 7,[10][11][12][13][14][15] The thoracoscopic mini-Maze we describe is safe and effective at early follow up and is less invasive than the Cox maze procedure. This technique avoids the need for a sternotomy or rib-spreading thoracotomy and is performed on a beating heart, avoiding the need for CPB and aortic cross-clamping.…”

Section: Discussionmentioning

confidence: 93%

Minimally Invasive Cardiothoracic Surgery for Atrial Fibrillation A Combined Japan-US Experience

Matsutani¹,

Takase

Ozeki³

et al. 2008

Circ J

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“…18,19 Regarding epicardial ablation therapies on a beating heart, several minimally invasive trials such as robot-assisted or total endoscopic ablation were reported. [20][21][22] However, those studies still required placement of more than two ports. We aim for achieving ablation therapy by using the ARM with minimized port incision, that is, one-port approach.…”

Section: Discussionmentioning

confidence: 99%

Epicardial Atrial Ablation Using a Novel Articulated Robotic Medical Probe via a Percutaneous Subxiphoid Approach

Ota

Degani

Zubiate

et al. 2006

Innovations�(Phila)

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Objective Minimally invasive epicardial atrial ablation to cure atrial fibrillation through the use of a percutaneous subxiphoid approach currently has a lack of dedicated technology for intrapericardial navigation around the beating heart. We have developed a novel articulated robotic medical probe and performed preliminary experiments in a porcine preparation. Methods In five large, healthy pigs, the teleoperated robotic system was introduced inside the pericardial space through a percutaneous subxiphoid approach. Secondary visualization of the left atrium and left atrial appendage was achieved with the use of a 5-mm scope inserted through a left thoracic port. The operator actively controlled the path of the robot by using a master manipulator. The catheter, with an irrigated radiofrequency tip, was guided through the working port of the robot to achieve epicardial ablation of the left atrium. Results Access to the pericardial space and progression around the left atrium was successful in all cases, with no interference with the beating heart such as a fatal arrhythmia, unexpected bleeding, and hypotension. Epicardial ablation was successfully performed in all five cases. No adverse hemodynamic or electrophysiological events were noted during the trials. When the animals were killed, there was no visually detected injury on the surrounding mediastinal structures caused by ablation. Transmural ablation was confirmed by histopathology of the left atrium. Conclusions We have developed a dedicated articulated robotic medical probe and successfully performed epicardial left atrial radiofrequency ablation. Based on the feedback from these preliminary experiments, the radius of curvature and proper visualization of the device are being improved in the next generation prototype.

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Totally Endoscopic Ablation of Lone Atrial Fibrillation: Initial Clinical Experience

Cited by 97 publications

References 20 publications

Advances in Surgical Treatment of Atrial Fibrillation

Advances in Surgical Treatment of Atrial Fibrillation

Minimally Invasive Cardiothoracic Surgery for Atrial Fibrillation A Combined Japan-US Experience

Epicardial Atrial Ablation Using a Novel Articulated Robotic Medical Probe via a Percutaneous Subxiphoid Approach

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