Electrophysiological findings after surgical ablation of atrial
fibrillation using AtriCure system

J 2017

Electrophysiological findings after surgical ablation of atrial fibrillation using AtriCure system

BULAVA, Alan, Ales MOKRACEK, Martin EISENBERGER, Vojtech KURFIRST, Ladislav DUŠEK et. al.

Basic information

Original name

Electrophysiological findings after surgical ablation of atrial fibrillation using AtriCure system

Authors

BULAVA, Alan (203 Czech Republic), Ales MOKRACEK (203 Czech Republic), Martin EISENBERGER (203 Czech Republic), Vojtech KURFIRST (203 Czech Republic) and Ladislav DUŠEK (203 Czech Republic, guarantor, belonging to the institution)

Edition

Cor et Vasa, AMSTERDAM, ELSEVIER SCIENCE BV, 2017, 0010-8650

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30201 Cardiac and Cardiovascular systems

Country of publisher

Netherlands

Confidentiality degree

není předmětem státního či obchodního tajemství

RIV identification code

RIV/00216224:14110/17:00098098

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1016/j.crvasa.2017.04.002

UT WoS

000410033600013

Keywords in English

Atrial fibrillation ablation; Hybrid approaches; Electrophysiological mapping; Reconduction

Abstract

V originále

Introduction: Long-term results of catheter ablation (CA) of persistent and long-standing persistent atrial fibrillation (AF) have been disappointing. The hybrid approach is one method of overcoming the limitations of CA. Aim: To present electrophysiological (EP) findings in patients undergoing hybrid surgical ablation to treat atrial fibrillation. Methods: Patients with persistent and long-standing persistent AF underwent thoracoscopic epicardial radiofrequency (RF) isolation of the pulmonary veins (PV) using AtriCure clamps followed by linear ablations in the left atrium (LA) using a linear pen and complemented by Marshall ligament disruption and left atrial appendage exclusion using an AtriClip device. As part of the study protocol, all patients underwent an EP study and RF ablation to eliminate any and all residual epicardial conduction gaps. Results: Seventy patients (49 male, median 63.5 years) were recruited for the study. The EP-phase of the study was performed 87 days (median) after the thoracoscopic ablation. At the time of the EP study, 76% of patients presented with sinus rhythm (SR), 7% with typical atrial flutter, 11% with atrial tachycardia, and 6% with AF. Left sided PVs were found to be isolated less often than right PVs (75.7% vs. 91.4%, p < 0.001). Complete isolation of all PVs was seen in 68.6% of patients. Complete isolation of the LA posterior wall was found in 22.9% of patients only. Conduction gaps in the left PVs were mostly found on the superior portion and on the ridge between the superior vein and LA appendage. In the right PVs, gaps were most often on the superior and posterior walls of the vessels. It was impossible to find typical gap locations on the LA roof connecting line since most patients required re-ablation of the whole line. The most common re-conduction site on the inferior line was found on the third of the line adjacent to the right inferior PV. Conclusion: Surgical epicardial ablation of the right sided PVs is significantly more successful compared to ablation of left-sided PVs. Linear epicardial ablations, completed under direct visual control are often unsuccessful. Our results may help cardiac surgeons focus on the typical sites of re-conduction and improve their results through additional RF applications. (C) 2017 The Czech Society of Cardiology. Published by Elsevier Sp. zo.o. All rights reserved.

Citovat

BULAVA, Alan, Ales MOKRACEK, Martin EISENBERGER, Vojtech KURFIRST and Ladislav DUŠEK. Electrophysiological findings after surgical ablation of atrial fibrillation using AtriCure system. Cor et Vasa. AMSTERDAM: ELSEVIER SCIENCE BV, 2017, vol. 59, No 4, p. "E359"-"E366", 8 pp. ISSN 0010-8650. Available from: https://dx.doi.org/10.1016/j.crvasa.2017.04.002.

@article{1394054,
   author = {Bulava, Alan and Mokracek, Ales and Eisenberger, Martin and Kurfirst, Vojtech and Dušek, Ladislav},
   article_location = {AMSTERDAM},
   article_number = {4},
   doi = {http://dx.doi.org/10.1016/j.crvasa.2017.04.002},
   keywords = {Atrial fibrillation ablation; Hybrid approaches; Electrophysiological mapping; Reconduction},
   language = {eng},
   issn = {0010-8650},
   journal = {Cor et Vasa},
   title = {Electrophysiological findings after surgical ablation of atrial fibrillation using AtriCure system},
   volume = {59},
   year = {2017}
}

TY  - JOUR
ID  - 1394054
AU  - Bulava, Alan - Mokracek, Ales - Eisenberger, Martin - Kurfirst, Vojtech - Dušek, Ladislav
PY  - 2017
TI  - Electrophysiological findings after surgical ablation of atrial fibrillation using AtriCure system
JF  - Cor et Vasa
VL  - 59
IS  - 4
SP  - "E359"-"E366"
EP  - "E359"-"E366"
PB  - ELSEVIER SCIENCE BV
SN  - 00108650
KW  - Atrial fibrillation ablation
KW  - Hybrid approaches
KW  - Electrophysiological mapping
KW  - Reconduction
N2  - Introduction: Long-term results of catheter ablation (CA) of persistent and long-standing persistent atrial fibrillation (AF) have been disappointing. The hybrid approach is one method of overcoming the limitations of CA. Aim: To present electrophysiological (EP) findings in patients undergoing hybrid surgical ablation to treat atrial fibrillation. Methods: Patients with persistent and long-standing persistent AF underwent thoracoscopic epicardial radiofrequency (RF) isolation of the pulmonary veins (PV) using AtriCure clamps followed by linear ablations in the left atrium (LA) using a linear pen and complemented by Marshall ligament disruption and left atrial appendage exclusion using an AtriClip device. As part of the study protocol, all patients underwent an EP study and RF ablation to eliminate any and all residual epicardial conduction gaps. Results: Seventy patients (49 male, median 63.5 years) were recruited for the study. The EP-phase of the study was performed 87 days (median) after the thoracoscopic ablation. At the time of the EP study, 76% of patients presented with sinus rhythm (SR), 7% with typical atrial flutter, 11% with atrial tachycardia, and 6% with AF. Left sided PVs were found to be isolated less often than right PVs (75.7% vs. 91.4%, p < 0.001). Complete isolation of all PVs was seen in 68.6% of patients. Complete isolation of the LA posterior wall was found in 22.9% of patients only. Conduction gaps in the left PVs were mostly found on the superior portion and on the ridge between the superior vein and LA appendage. In the right PVs, gaps were most often on the superior and posterior walls of the vessels. It was impossible to find typical gap locations on the LA roof connecting line since most patients required re-ablation of the whole line. The most common re-conduction site on the inferior line was found on the third of the line adjacent to the right inferior PV. Conclusion: Surgical epicardial ablation of the right sided PVs is significantly more successful compared to ablation of left-sided PVs. Linear epicardial ablations, completed under direct visual control are often unsuccessful. Our results may help cardiac surgeons focus on the typical sites of re-conduction and improve their results through additional RF applications. (C) 2017 The Czech Society of Cardiology. Published by Elsevier Sp. zo.o. All rights reserved.
ER  -

BULAVA, Alan, Ales MOKRACEK, Martin EISENBERGER, Vojtech KURFIRST and Ladislav DUŠEK. Electrophysiological findings after surgical ablation of atrial fibrillation using AtriCure system. \textit{Cor et Vasa}. AMSTERDAM: ELSEVIER SCIENCE BV, 2017, vol.~59, No~4, p.~''E359''-''E366'', 8 pp. ISSN~0010-8650. Available from: https://dx.doi.org/10.1016/j.crvasa.2017.04.002.

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