Thoracoscopic surgical atrial fibrillation ablation in patients with an extremely enlarged left atrium
| Autor: | Nicoline W.E. van den Berg, Jonas S.S.G. de Jong, F R Piersma, Robin Wesselink, Antoine H.G. Driessen, Wim-Jan van Boven, J. Neefs, Joris R. de Groot |
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| Přispěvatelé: | ACS - Heart failure & arrhythmias, Cardiology, Graduate School, Cardiothoracic Surgery, ACS - Pulmonary hypertension & thrombosis |
| Jazyk: | angličtina |
| Rok vydání: | 2022 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Left atrium Atrial tachycardia Pulmonary vein isolation Pulmonary vein Left atrial Recurrence Minimally invasive surgery Physiology (medical) Internal medicine Atrial Fibrillation medicine Humans In patient Heart Atria business.industry Atrial fibrillation Atrial fibrosis Ablation medicine.disease Log-rank test medicine.anatomical_structure Treatment Outcome Pulmonary Veins Cardiology Catheter Ablation Female medicine.symptom Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of interventional cardiac electrophysiology, 64(2), 469-478. Springer Netherlands |
| ISSN: | 1383-875X |
| Popis: | 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/m2. 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/m2), while 374 (84.6%) had a smaller LA (LAVI: 34.8 [29.2–41.3] ml/m2). 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 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. |
| Databáze: | OpenAIRE |
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