Catheter ablation vs electrophysiologically guided thoracoscopic surgical ablation in long-standing persistent atrial fibrillation: The CASA-AF Study

Haldar, Shouvik; Jones, David G.; Bahrami, Toufan; Souza, Anthony De; Panikker, Sandeep; Butcher, Charlie; Khan, Habib; Yahdav, Rashmi; Jarman, Julian W.E.; Mantziari, Lilian; Nyktari, Eva; Mohiaddin, Raad H.; Hussain, Wajid; Markides, Vias; Wong, Tom

doi:10.1016/j.hrthm.2017.08.024

Cited by 31 publications

(13 citation statements)

References 19 publications

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“…Most studies comparing VATS with CA recruited patients from 2006 to 2011, a period during which CA technology was rapidly evolving, and before contact force-sensing catheters were available. The 12-month success rates from CA in these studies are as low as 30% for paroxysmal 16 and 32% for persistent AF, 19 considerably lower than the 65% 20 reported in a recent meta-analyses of CA for persistent AF. However, the pooled estimates from meta-analyses of CA are similar to the results from CA presented here, suggesting that as CA technology has improved, the previously seen advantages of VATS AF ablation may no longer be as apparent.…”

Section: Discussioncontrasting

confidence: 71%

Early experience of thoracoscopic vs. catheter ablation for atrial fibrillation

et al. 2019

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Aims Video-assisted thoracoscopic surgery (VATS) ablation has been advocated as a treatment option for non-paroxysmal atrial fibrillation (AF) in recent guidelines. Real-life data on its safety and efficacy during a centre’s early experience are sparse. Methods and results Thirty patients (28 persistent/longstanding persistent AF) underwent standalone VATS ablation for AF by an experienced thoracoscopic surgeon, with the first 20 cases proctored by external surgeons. Procedural and follow-up outcomes were collected prospectively, and compared with 90 propensity-matched patients undergoing contemporaneous catheter ablation (CA). Six (20.0%) patients undergoing VATS ablation experienced ≥1 major complication (death n = 1, stroke n = 2, conversion to sternotomy n = 3, and phrenic nerve injury n = 2). This was significantly higher than the 1.1% major complication rate (tamponade requiring drainage n = 1) seen with CA ( P < 0.001). Twelve-month single procedure arrhythmia-free survival rates without antiarrhythmic drugs were 56% in the VATS and 57% in the CA cohorts ( P = 0.22), and 78% and 80%, respectively given an additional CA and antiarrhythmic drugs ( P = 0.32). Conclusion During a centre’s early experience, VATS ablation may have similar success rates to those from an established CA service, but carry a greater risk of major complications. Those embarking on a programme of VATS AF ablation should be aware that complication and success rates may differ from those reported by selected high-volume centres.

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Section: Discussioncontrasting

confidence: 71%

Early experience of thoracoscopic vs. catheter ablation for atrial fibrillation

et al. 2019

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“…Such discrepancy suggests that the mechanisms involved in AF perpetuation may not be decisive for AF priming. Of interest, minimally invasive surgical ablation has shown that a poor termination rate does not preclude good long‐term results . With the notion of AF priming, we hypothesize that anatomical re‐entries randomly running through critical paths (CS‐VOM bundles, PV, anatomical isthmuses, etc.)…”

Section: Discussionmentioning

confidence: 97%

MARSHALL bundles elimination, Pulmonary veins isolation and Lines completion for ANatomical ablation of persistent atrial fibrillation: MARSHALL‐PLAN case series

Pambrun

Denis

Duchâteau

et al. 2018

Cardiovasc electrophysiol

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Introduction: Beyond pulmonary veins (PV) isolation, the ablation strategy for persistent atrial fibrillation (AF) remains controversial. Substrate ablation may provide a high termination rate but at the cost of impaired atrial physiology and recurrent complex re-entries. To overcome these pitfalls, we investigated a new lesion set based on important anatomical considerations. Methods and Results: The case series included 10 consecutive patients with persistent AF. Three atrial structures were successively targeted: (1) coronary sinus and vein of Marshall (CS-VOM) musculature elimination; (2) PVs isolation; and (3) anatomical isthmuses block. The lesion set completion was the procedural endpoint. Step 1: VOM ethanol infusion was feasible in all cases (mean time of 33.4 ± 9.4 minutes), mean radiofrequency (RF) time for CS-VOMbundles was 14.4 ± 6.9 minutes. Step 2: mean RF time for PV isolation was 27.7 ± 9.3 minutes. Step 3: mean RF time for mitral, roof, and cavotricuspid lines was 5.7 ± 2.3, 8.1 ± 4.3, and 5.9 ± 1.9 minutes, respectively. The lesion set was achieved in all patients. Mean procedure time was 270 ± 29.9 minutes. AF termination and noninducibility were, respectively, obtained in 50% and 90% of the patients. After a 6-month follow-up, all patients were free from arrhythmia recurrence. Conclusion:The present case series reports a new ablation strategy systematically targeting anatomical structures previously identified as possibly involved in the fibrillatory process and the recurrent tachycardias. The resulting lesion set provides good short-term outcomes. Although promising, these preliminary results need to be confirmed in the larger prospective study.

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“…Hybrid approaches complementing the thoracoscopic procedure with a catheter-based endocardial or epicardial mapping and ‘touch-up’ approach have been described in a single procedure setting, as well as in a staged setting [ 45 – 47 ]. Non-randomised data suggest that this approach is more efficacious than catheter ablation for persistent AF, and a randomised study on this issue is ongoing [ 48 ].…”

Section: Advanced Atrial Fibrillation: Treatment Challengesmentioning

confidence: 99%

Therapeutic options for patients with advanced atrial fibrillation: from lifestyle and medication to catheter and surgical ablation

2020

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Atrial fibrillation (AF) is part of a vicious cycle that includes multiple cardiovascular risk factors and comorbidity which can promote atrial remodelling and AF progression. Most AF-related risk factors-hypertension, diabetes, sleep apnoea, obesity and sedentary lifestyle-are in essence modifiable which may prevent AF development. Treatment of associated cardiovascular conditions may prevent both symptoms and future cardiovascular events. For advanced forms of symptomatic AF refractory to lifestyle management and optimal medication, invasive ablation therapies have become a cornerstone. Although electrical trigger isolation from the pulmonary veins is reasonably effective and safe, more potent energy sources including high output-short duration radiofrequency, ultra-low cryo-energy, and electroporation, as well as more sophisticated arrays, balloons, and lattice-tipped catheter tools, are on their way to eliminate existing pitfalls and simplify the procedure. Electroanatomical navigation and mapping systems are becoming available to provide real-time information on ablation lesion quality and the critical pathways of AF in the individual patient to guide more extensive ablation strategies that may enhance longterm outcome for freedom of advanced AF. Surgi

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Catheter ablation vs electrophysiologically guided thoracoscopic surgical ablation in long-standing persistent atrial fibrillation: The CASA-AF Study

Cited by 31 publications

References 19 publications

Early experience of thoracoscopic vs. catheter ablation for atrial fibrillation

Early experience of thoracoscopic vs. catheter ablation for atrial fibrillation

MARSHALL bundles elimination, Pulmonary veins isolation and Lines completion for ANatomical ablation of persistent atrial fibrillation: MARSHALL‐PLAN case series

Therapeutic options for patients with advanced atrial fibrillation: from lifestyle and medication to catheter and surgical ablation

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