Minimally invasive surgical ablation of atrial fibrillation: six-month results
| Autor: | Morley A. Herbert, Bryan M. Steinberg, Marc W. Gerdisch, Syma L. Prince, David Duke, Michael J. Mack, James R. Edgerton, Scott H. Bronleewe, James H. McClelland, Shannon Hoffman |
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| Rok vydání: | 2008 |
| Předmět: |
Pulmonary and Respiratory Medicine
Male medicine.medical_specialty Heart disease medicine.medical_treatment Pulmonary vein Lesion Electrocardiography Heart Rate Internal medicine Atrial Fibrillation medicine Humans Minimally Invasive Surgical Procedures Normal Sinus Rhythm business.industry Thoracic Surgery Video-Assisted Atrial fibrillation Middle Aged Ablation medicine.disease Surgery Circulatory system Cardiology Catheter Ablation Electrocardiography Ambulatory Female medicine.symptom Cardiology and Cardiovascular Medicine business Surgical ablation |
| Zdroj: | The Journal of thoracic and cardiovascular surgery. 138(1) |
| ISSN: | 1097-685X |
| Popis: | Background A minimally invasive surgery for treatment of atrial fibrillation was developed with bilateral pulmonary vein isolation, mapping, and ablation of the ganglionic plexi and excision of the left atrial appendage. A prospective multicenter registry was created to evaluate the outcomes. Methods The procedure was performed through bilateral minithoracotomies with video assistance. It included bilateral pulmonary vein isolation with bipolar radiofrequency with documentation of conduction block, location of ganglionic plexi by high-frequency stimulation, and appropriate ablation and left atrial appendage exclusion/excision. Clinical follow-up at 6 months included monitoring with electrocardiogram, Holter, event monitor, or pacemaker interrogation. Results One hundred fourteen patients with 60 (52.6%) paroxysmal, 32 (28.1%) persistent, and 22 (19.3%) long-standing persistent atrial fibrillations were treated. The mean age was 59.5 ± 10.6 years, and 69.3% were men. The mean follow-up period was 204 ± 41 days (median 195). There were 2 (1.8%) operative mortalities. At 6-month follow-up, with long-term monitoring, 52/60 (86.7%) patients with paroxysmal fibrillations were in normal sinus rhythm and 43/60 (71.7%) were both in normal sinus rhythm and off antiarrhythmic drugs. The patients with persistent atrial fibrillation had a lower success rate, with 18/32 (56.3%) being in normal sinus rhythm and 46.9% both in normal sinus rhythm and off antiarrhythmic drugs; for long-standing persistent cases, 11/22 (50%) were in normal sinus rhythm and 7/22 (31.9%) were also off antiarrhythmic drugs. Conclusions Minimally invasive atrial fibrillation surgery is an effective treatment of paroxysmal atrial fibrillation at 6 months. Continuous event monitoring is necessary to accurately assess treatment results. A more extensive lesion set seems to be required for treatment of persistent atrial fibrillation. |
| Databáze: | OpenAIRE |
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