Background: Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and is associated with an increased risk of death, progression of heart failure, and the development of cardiogenic thromboemboli. Despite the significant success in the management of AF in the paroxysmal form, the results of the treatment for patients with persistent forms of AF remain unsatisfactory. Though the surgical approach provides higher rates of efficiency regarding the restoration of a sinus rhythm, transmural lesions are not always attainable, as a result, the rate of AF recurrence in the long-term period remains fairly high. It is also impossible to create ablative patterns to the mitral and tricuspid valves during thoracoscopic epicardial ablation, which can cause the development of recurrent AF, perimitral and typical atrial flutter. Therefore, the development of hybrid approaches combining the advantages of catheter and thoracoscopic techniques is an urgent task of contemporary surgical and interventional arrhythmology. Aims: to estimate the immediate results of a hybrid approach in the management of patients with persistent AF. Methods: We report the first experience of a hybrid treatment of patients with persistent AF. 6 patients aged 53-64 years (1 female, 5 males) were included in the study. At the first stage, thoracoscopic epicardial bipolar ablation was performed (modified GALAXY protocol); the second stage (in 3 to 6 months after the thoracoscopic stage) included an intracardiac electrophysiological study with three-dimensional endocardial mapping followed by endocardial ablation. Results: The thoracoscopic stage of the hybrid treatment included ablation according to the box lesion scheme using a bipolar irrigation equipment. No lethal outcomes and severe, life-threatening complications were registered. The duration of the inpatient period was 510 hospital-days. The 2nd stage of the hybrid treatment was limited to intracardiac electrophysiological examination only in 2 patients. In 4 patients, epicardial radiofrequency ablation was complemented by endocardial radiofrequency exposure. In 3 of the 4 patients who underwent endocardial radiofrequency ablation, catheter ablation of the mitral and cavotricuspid isthmus was required because of the induction of perimitral and typical flutter, respectively. After the 2nd stage of the hybrid treatment, at the time of discharge all the patients maintained a stable sinus rhythm. There were no severe complications or lethal outcomes. Conclusion: a hybrid approach in the AF management is a safe and effective method of treatment, which combines the advantages of minimally invasive surgery and endocardial intervention in patients with persistent AF. The technique is safe and has acceptable short-term results.
Background One of the most arrhythmias associated with atrial fibrillation (AF) is typical atrial flutter (AFL). The main methods of surgical treatment of these arrhythmias is catheter ablation. The problem of catheter ablation strategy for these coexistentarrhythmias is not solved. Purpose: To assess the effectiveness of long-term maintenance of sinus rhythm in a two-stage approach to the interventional treatment of atrial fibrillation associated with typical atrial flutter. Methods: The study included 34 patients aged 41-82 years with AF and coexistent typical AFL. Female 11 (32,35%), male 23 (67,35%). Randomization 1:1. Group 1 (n=17) has been performed radiofrequency ablation (RFA) of the cavotricuspid isthmus (CTI) with radiofrequency catheter isolation of the PV. Group 2 (n=17) has been performed only RFA of CTI. AF and AFL recurrences rate has been evaluated in both groups. Follow-up period 12 months. Results: Procedure duration and fluoroscopy time were less in group 2 that those in group 1. Extended intervention in group 1 was accompanied with complications in two cases. There were no significant differences in AF recurrence rate in both groups (p=0,43183). AFL recurrences has not been found in both groups. Conclusion: One stage ablation approach in AF patients with coexistent AFLassociated with increaseprocedure duration and fluoroscopy time. The frequency of AF recurrence in patients who underwent extended intervention (catheter isolation of the PV and RFA CTI) and in patients who underwent only the elimination of typical atrial flutter, was not statistically significantly different (p = 0.43183). In the presence of AF and typical atrial flutter, a two-stage approach to interventional treatment should be regarded as appropriate.
The problem of anticoagulant therapy after successful atrial flutter catheter ablation has still not been resolved despite the socio-economic importance of cardiogenic thromboembolism prevention in atrial flutter. Current anticoagulation strategy in patients with atrial flutter based on guidelines for atrial fibrillation. Inappropriate anticoagulation strategy in patients with atrial flutter is a cause of thromboembolic complications. On the other hand, these patients have a high risk of post procedural bleeding.
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