Lesion durability found during mandated percutaneous catheter
ablation after surgical cryo-ablation for treatment of
non-paroxysmal atrial fibrillation

J 2024

Lesion durability found during mandated percutaneous catheter ablation after surgical cryo-ablation for treatment of non-paroxysmal atrial fibrillation

BULAVA, Alan, Ales MOKRACEK, Petr NĚMEC, Dan WICHTERLE, Pavel OSMANCIK et. al.

Basic information

Original name

Lesion durability found during mandated percutaneous catheter ablation after surgical cryo-ablation for treatment of non-paroxysmal atrial fibrillation

Authors

BULAVA, Alan (203 Czech Republic), Ales MOKRACEK (203 Czech Republic), Petr NĚMEC (203 Czech Republic, belonging to the institution), Dan WICHTERLE (203 Czech Republic), Pavel OSMANCIK (203 Czech Republic), Petr BUDERA (203 Czech Republic), Petr KACER (203 Czech Republic), Linda VETEŠKOVÁ (703 Slovakia, belonging to the institution), Tomas SKALA (203 Czech Republic), Petr SANTAVY (203 Czech Republic), Jan CHOVANCIK (203 Czech Republic), Piotr BRANNY (203 Czech Republic), Vitalii RIZOV (203 Czech Republic), Miroslav KOLESAR (203 Czech Republic), Iva SAFARIKOVA (203 Czech Republic) and Marian RYBAR (203 Czech Republic)

Edition

Journal of Cardiothoracic Surgery, London, BMC, 2024, 1749-8090

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30201 Cardiac and Cardiovascular systems

Country of publisher

United Kingdom of Great Britain and Northern Ireland

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 1.600 in 2022

Organization unit

Faculty of Medicine

DOI

http://dx.doi.org/10.1186/s13019-024-02889-3

UT WoS

001258112200009

Keywords in English

Concomitant atrial fibrillation ablation; Staged hybrid ablation; CryoMaze procedure; Electrical conduction; Electrophysiological study; Gaps localization

Abstract

V originále

Objectives Current recommendations support surgical treatment of atrial fibrillation (AF) in patients indicated for cardiac surgery. These procedures are referred to as concomitant and may be carried out using radiofrequency energy or cryo-ablation. This study aimed to assess the electrophysiological findings in patients undergoing concomitant cryo-ablation. Methods Patients with non-paroxysmal AF undergoing coronary artery bypass grafting and/or valve repair/replacement were included in the trial if concomitant cryo-ablation was part of the treatment plan according to current guidelines. The patients reported in this study were assigned to undergo staged percutaneous radiofrequency catheter ablation (PRFCA), i.e., hybrid treatment, as a part of the SURHYB trial protocol. Results We analyzed 103 patients who underwent PRFCA 105 +/- 35 days after surgery. Left and right pulmonary veins (PVs) were found isolated in 65 (63.1%) and 63 (61.2%) patients, respectively. The LA posterior wall isolation and mitral isthmus conduction block were found in 38 (36.9%) and 18 (20.0%) patients, respectively. Electrical reconnections (gaps) in the left PVs were more often localized superiorly than inferiorly (57.9% vs. 26.3%, P = 0.005) and anteriorly than posteriorly (65.8% vs. 31.6%, P = 0.003). Gaps in the right PVs were more equally distributed anteroposteriorly but dominated in superior segments (72.5% vs. 40.0%, P = 0.003). There was a higher number of gaps on the roof line compared to the inferior line (131 (67.2%) vs. 67 (42.2%), P < 0.001). Compared to epicardial cryo-ablation, endocardial was more effective in creating PVs and LA posterior wall isolation (P < 0.05). Cryo-ablation using nitrous oxide (N20) or argon (Ar) gas as cooling agents was similarly effective (P = NS). Conclusions The effectiveness of surgical cryo-ablation in achieving transmural and durable lesions in the left atrium is surprisingly low. Gaps are located predominantly in the superior and anterior portions of the PVs and on the roof line. Endocardial cryo-ablation is more effective than epicardial ablation, irrespective of the cooling agent used.

Citovat

BULAVA, Alan, Ales MOKRACEK, Petr NĚMEC, Dan WICHTERLE, Pavel OSMANCIK, Petr BUDERA, Petr KACER, Linda VETEŠKOVÁ, Tomas SKALA, Petr SANTAVY, Jan CHOVANCIK, Piotr BRANNY, Vitalii RIZOV, Miroslav KOLESAR, Iva SAFARIKOVA and Marian RYBAR. Lesion durability found during mandated percutaneous catheter ablation after surgical cryo-ablation for treatment of non-paroxysmal atrial fibrillation. Journal of Cardiothoracic Surgery. London: BMC, 2024, vol. 19, No 1, p. 1-10. ISSN 1749-8090. Available from: https://dx.doi.org/10.1186/s13019-024-02889-3.

@article{2418122,
   author = {Bulava, Alan and Mokracek, Ales and Němec, Petr and Wichterle, Dan and Osmancik, Pavel and Budera, Petr and Kacer, Petr and Vetešková, Linda and Skala, Tomas and Santavy, Petr and Chovancik, Jan and Branny, Piotr and Rizov, Vitalii and Kolesar, Miroslav and Safarikova, Iva and Rybar, Marian},
   article_location = {London},
   article_number = {1},
   doi = {http://dx.doi.org/10.1186/s13019-024-02889-3},
   keywords = {Concomitant atrial fibrillation ablation; Staged hybrid ablation; CryoMaze procedure; Electrical conduction; Electrophysiological study; Gaps localization},
   language = {eng},
   issn = {1749-8090},
   journal = {Journal of Cardiothoracic Surgery},
   title = {Lesion durability found during mandated percutaneous catheter ablation after surgical cryo-ablation for treatment of non-paroxysmal atrial fibrillation},
   url = {https://cardiothoracicsurgery.biomedcentral.com/articles/10.1186/s13019-024-02889-3},
   volume = {19},
   year = {2024}
}

TY  - JOUR
ID  - 2418122
AU  - Bulava, Alan - Mokracek, Ales - Němec, Petr - Wichterle, Dan - Osmancik, Pavel - Budera, Petr - Kacer, Petr - Vetešková, Linda - Skala, Tomas - Santavy, Petr - Chovancik, Jan - Branny, Piotr - Rizov, Vitalii - Kolesar, Miroslav - Safarikova, Iva - Rybar, Marian
PY  - 2024
TI  - Lesion durability found during mandated percutaneous catheter ablation after surgical cryo-ablation for treatment of non-paroxysmal atrial fibrillation
JF  - Journal of Cardiothoracic Surgery
VL  - 19
IS  - 1
SP  - 1-10
EP  - 1-10
PB  - BMC
SN  - 17498090
KW  - Concomitant atrial fibrillation ablation
KW  - Staged hybrid ablation
KW  - CryoMaze procedure
KW  - Electrical conduction
KW  - Electrophysiological study
KW  - Gaps localization
UR  - https://cardiothoracicsurgery.biomedcentral.com/articles/10.1186/s13019-024-02889-3
N2  - Objectives Current recommendations support surgical treatment of atrial fibrillation (AF) in patients indicated for cardiac surgery. These procedures are referred to as concomitant and may be carried out using radiofrequency energy or cryo-ablation. This study aimed to assess the electrophysiological findings in patients undergoing concomitant cryo-ablation. Methods Patients with non-paroxysmal AF undergoing coronary artery bypass grafting and/or valve repair/replacement were included in the trial if concomitant cryo-ablation was part of the treatment plan according to current guidelines. The patients reported in this study were assigned to undergo staged percutaneous radiofrequency catheter ablation (PRFCA), i.e., hybrid treatment, as a part of the SURHYB trial protocol. Results We analyzed 103 patients who underwent PRFCA 105 +/- 35 days after surgery. Left and right pulmonary veins (PVs) were found isolated in 65 (63.1%) and 63 (61.2%) patients, respectively. The LA posterior wall isolation and mitral isthmus conduction block were found in 38 (36.9%) and 18 (20.0%) patients, respectively. Electrical reconnections (gaps) in the left PVs were more often localized superiorly than inferiorly (57.9% vs. 26.3%, P = 0.005) and anteriorly than posteriorly (65.8% vs. 31.6%, P = 0.003). Gaps in the right PVs were more equally distributed anteroposteriorly but dominated in superior segments (72.5% vs. 40.0%, P = 0.003). There was a higher number of gaps on the roof line compared to the inferior line (131 (67.2%) vs. 67 (42.2%), P < 0.001). Compared to epicardial cryo-ablation, endocardial was more effective in creating PVs and LA posterior wall isolation (P < 0.05). Cryo-ablation using nitrous oxide (N20) or argon (Ar) gas as cooling agents was similarly effective (P = NS). Conclusions The effectiveness of surgical cryo-ablation in achieving transmural and durable lesions in the left atrium is surprisingly low. Gaps are located predominantly in the superior and anterior portions of the PVs and on the roof line. Endocardial cryo-ablation is more effective than epicardial ablation, irrespective of the cooling agent used.
ER  -

BULAVA, Alan, Ales MOKRACEK, Petr NĚMEC, Dan WICHTERLE, Pavel OSMANCIK, Petr BUDERA, Petr KACER, Linda VETEŠKOVÁ, Tomas SKALA, Petr SANTAVY, Jan CHOVANCIK, Piotr BRANNY, Vitalii RIZOV, Miroslav KOLESAR, Iva SAFARIKOVA and Marian RYBAR. Lesion durability found during mandated percutaneous catheter ablation after surgical cryo-ablation for treatment of non-paroxysmal atrial fibrillation. \textit{Journal of Cardiothoracic Surgery}. London: BMC, 2024, vol.~19, No~1, p.~1-10. ISSN~1749-8090. Available from: https://dx.doi.org/10.1186/s13019-024-02889-3.

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