Thoracoscopic surgical atrial fibrillation ablation in patients with an extremely enlarged left atrium.

Autor: Neefs J; Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands., Wesselink R; Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands., van den Berg NWE; Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands., de Jong JSSG; Department of Cardiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands., Piersma FR; Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands., van Boven WP; Department of Cardiothoracic Surgery, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands., Driessen AHG; Department of Cardiothoracic Surgery, Heart Center, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands., de Groot JR; Department of Cardiology, Heart Center, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. j.r.degroot@amsterdamumc.nl.
Jazyk: angličtina
Zdroj: Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing [J Interv Card Electrophysiol] 2022 Aug; Vol. 64 (2), pp. 469-478. Date of Electronic Publication: 2021 Sep 16.
DOI: 10.1007/s10840-021-01056-1
Abstrakt: Purpose: Efficacy of pulmonary vein isolation (PVI) for atrial fibrillation (AF) decreases as left atrial (LA) volume increases. However, surgical AF ablation with unknown efficacy is being performed in patients with a giant LA (GLA). We determined efficacy of thoracoscopic AF ablation in patients with compared to without a GLA.
Methods: Patients underwent thoracoscopic PVI with additional left atrial ablations lines (in persistent AF) and were prospectively followed up. GLA was defined as LA volume index (LAVI) ≥ 50 ml/m 2 . Follow-up was performed with ECGs and 24-h Holters every 3 months. After a 3-month blanking period, all antiarrhythmic drugs were discontinued. The primary outcome was freedom of any atrial tachyarrhythmia ≥ 30 s during 2 years of follow-up.
Results: At baseline, 68 (15.4%) patients had a GLA (LAVI: 56.7 [52.4-62.8] ml/m 2 ), while 374 (84.6%) had a smaller LA (LAVI: 34.8 [29.2-41.3] ml/m 2 ). GLA patients were older (61.9 ± 6.9 vs 59.4 ± 8.8 years, p = 0.02), more often diagnosed with persistent AF (76.5% vs 58.6%, p = 0.008). Sex was equally distributed (with approximately 25% females). GLA patients had more recurrences compared to non-GLA patients at 2-year follow-up (42.6% vs 57.2%, log rank p = 0.02). Freedom of AF was 69.0% in non-GLA paroxysmal AF patients compared to 43.8-49.3% in a combined group of GLA and/or persistent AF patients(log rank p < 0.001). Furthermore, freedom was 62.4% in non-GLA male patients, compared to 43.8-47.4 in a combined group of GLA and/or female sex(log rank p = 0.02).
Conclusion: Thoracoscopic AF ablation is an effective therapy in a substantial part of GLA patients. Thoracoscopic AF ablation may serve as a last resort treatment option in these patients.
(© 2021. The Author(s).)
Databáze: MEDLINE
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