Analysis of the causes and frequency of permanent pacemaker implantation after different variants of surgical treatment of atrial fibrillation with combined cardiac surgery

Antipov, G. N.; Постол, А. С.; Kotov, S. N.; Makarova, M. O.; Schneider, Yecheskel

doi:10.33029/2308-1198-2021-9-4-48-56

Clinical and Experimental Surgery. Petrovsky journal

2021

DOI: 10.33029/2308-1198-2021-9-4-48-56

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Analysis of the causes and frequency of permanent pacemaker implantation after different variants of surgical treatment of atrial fibrillation with combined cardiac surgery

G. N. Antipov¹,

А. С. Постол²,

S. N. Kotov³

et al.

Abstract: Цель исследования -провести ретроспективный анализ причин и частоты имплантации электрокардиостимуляторов (ЭКС) после различных вариантов хирургического лечения фибрилляции предсердий (ФП) при сочетанных операциях на сердце. Материал и методы. С января 2013 по февраль 2021 г. прооперированы 558 пациентов по 4 вариантам хирургического лечения ФП и сочетанных вмешательств на сердце: 1 -классический вариант процедуры «лабиринт» III (cut-and-sew, БА-«лабиринт»), 2 -левопредсердная часть «лабиринт» III (ЛП-«лабирин… Show more

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Analysis of the endocardial stage of treatment of tachyarhythmias after open interventions for atrial fibrillation. Experience of one center

Postol,

Antipov,

Ivanchenko

et al. 2024

Cardiac Arrhythmias

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AIM: To study EFI parameters and features of recurrent atrial tachyarrhythmias in patients who underwent surgical correction of AF. MATERIALS AND METHODS: from January 2013 to December 2021, 447 combined interventions were performed to eliminate AF using the labyrinth-3 and left atrial labyrinth techniques with correction of CHD (congenital heart disease) and/or coronary artery disease. Rhythm disturbances were detected in 57 (12.7%) patients at various follow-up periods. Endovascular interventions were performed in 39 patients. The average follow-up period after the endocardial stage was 34.37 (standard deviation 24.32) months. The median age of patients was 64 (58–67) years, 21 (54%) were men. The patients were divided into 2 groups: group 1 — after the classic biatrial (BA) labyrinth-3 — 23 (59%) patients, group 2 — after the left-atrial variant (LA) labyrinth-3 — 16 (41%) patients. At the endocardial stage, electrophysiological studies (EFI) were performed to clarify the mechanism of arrhythmia, and ablation eliminated tachyarrhythmia. EFI protocol: revision of the pulmonary veins, determination of the isolation of the posterior wall of the LA assessment of atrial arrhythmia, elimination of arrhythmia, control induction of arrhythmia after ablation. After repeated intervention, patients were observed in the operating clinic every 3 months. RESULTS: After the endocardial stage, a regular rhythm was determined in 19 (82.6%) patients of the BA group, 13 (92.9%) patients of the LA group (p = 0.914). Relapses in the form of AF were noted in 5 patients (4 — group 1 and 1 — group 2) group (p = 0.306) All relapses of tachyarrhythmia with an irregular cycle (AF) were detected in patients with AF before the endovascular stage In both groups, there were cases of restoration of conduction in the pulmonary veins — 10 (43.5%) patients after BA ablation and 1 (5.3%) patient after LA ablation. There are no recurrences of atrial arrhythmia after ablation of atrial flutter (arrhythmia with a stable cycle). CONCLUSION: The endocardial stage is highly effective and demonstrates subsequent freedom from atrial arrhythmia in patients who have tachycardia with a regular cycle after both methods of surgical ablation of AF. Recurrent tachyarrhythmia in the form of AF (irregular cycle) is associated with a low probability of maintaining a regular atrial rhythm after a repeated endocardial procedure, due to the presence of structural and electrophysiological changes in the atrial myocardium.

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Analysis of the endocardial stage of treatment of tachyarhythmias after open interventions for atrial fibrillation. Experience of one center

Postol,

Antipov,

Ivanchenko

et al. 2024

Cardiac Arrhythmias

View full text Add to dashboard Cite

show abstract

Atrial remodelling comparison after maze-3 and cryo-maze procedures in combined cardiac interventions: a retrospective study

Antipov¹,

Постол²,

Kotov³

et al. 2022

Kuban. nauсh. med. vestnik

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Background. The maze procedure aims to eliminate atrial fibrillation (AF), restore sinus rhythm (SR) and atrial contractility. However, conflicting evidence exists regarding the extent of atrial remodelling in various techniques, which directed the focus of our study.Objectives. An atrial remodelling comparison after a cut-and-sew maze-3 surgery and its biatrial cryo-maze modification using 2D echocardiography.Methods. The study is a retrospective uncontrolled interrupted two-cohort time-series trial, with patients selected by pseudorandomisation according to a normal sinus rhythm-maintaining AF surgery method. A total of 217 maze-3 and 113 cryo-maze combined cardiac interventions have been performed within 2012–2021. The interventions included valve repair, coronary artery bypass grafting and their combination. Due to differences in long-term follow-up, the cohorts were pseudorandomised to select by 50 restored vs. maintained sinus rhythm patients using a nearest-neighbour classifier coupled with logistic regression. Mean follow-up period was 6 (1–17) months. The patients had paroxysmal, persistent and longstanding persistent AF. Echocardiography values prior to and long-term post-surgery were further analysed to determine the atrial remodelling dynamics. Results. A statistically significant atrial volume reduction is evident in a long-term within-cohort comparison. Meanwhile, a statistically more pronounced remodelling is observed between cohorts after maze-3 procedure. The cohort 1 vs. 2 estimates are: mean left atrial volume 120/125 mL3 (p = 0.011), left atrial size in apical view 52/53 mm (p = 0.023), right atrial size in apical view 58/62 mm (p = 0.004), right atrial size in parasternal short axis view 43/45 mm (p = 0.004), right atrial area in apical 4-chamber view 25/28 cm2 (p = 0.007). Maintained atrial pacing patients had positive systolic atrial function recovery rates (E/A ratio increased to average 1.5) in the long-term in both comparison cohorts.Conclusion. Remodelling is biatrial after all the maze procedures compared. A more pronounced atrial volume reduction occurs after maze-3 surgery. The presence of sinus rhythm is facilitated by cardiac conduction leading to mechanical and electrical remodelling of the atria.

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Analysis of the causes and frequency of permanent pacemaker implantation after different variants of surgical treatment of atrial fibrillation with combined cardiac surgery

Cited by 2 publications

References 0 publications

Analysis of the endocardial stage of treatment of tachyarhythmias after open interventions for atrial fibrillation. Experience of one center

Analysis of the endocardial stage of treatment of tachyarhythmias after open interventions for atrial fibrillation. Experience of one center

Atrial remodelling comparison after maze-3 and cryo-maze procedures in combined cardiac interventions: a retrospective study

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