Characteristics of symptomatic recurrent tachyarrhythmia after thoracoscopic ablation for persistent atrial fibrillation

Abstract

Background Recurrent atrial tachyarrhythmia (ATa) is a challenge in all ablation procedures for atrial fibrillation (AF). However, data on ATa after totally thoracoscopic ablation (TTA) is lacking. This study aimed to investigate the mechanisms and outcomes of recurrent ATa after TTA. Methods Eligible patients for the present study were those who underwent electrophysiologic study and catheter‐based radiofrequency ablation (RFA) at least 3 months after TTA for symptomatic recurrent ATa that was refractory to antiarrhythmic drugs and/or cardioversion. Follow‐up outcomes included recurrent ATa after first or repeated RFA. Results A consecutive 154 TTA patients were evaluated. A total of 24 patients showed symptomatic recurrent ATa after TTA, and 22 underwent RFA. Half of the patients (11/22, 50%) had AF as a form of recurrent ATa. Nonpulmonary vein (PV)‐related mechanisms of ATa were noted in half of patients. PV gaps showed a characteristic distribution: most gaps in right PVs were located at the posterior ridge (71.4%) with the posterior ridge of left PVs saved in all patients. Post‐RFA recurrence rate was 27.3% during a median follow‐up of 9.1 months, with all recurrences except for one occurring within 3 months after first RFA. Conclusions During a median of 17.8 months after TTA, 24 patients (24/154, 15.6%) developed symptomatic recurrent ATa, and 22 patients underwent RFA. Post‐RFA recurrence rate was 27.3%, which mostly occurred within 3 months after RFA. Catheter‐based ablation of recurrent arrhythmias may be effective, but challenging.

Is a hybrid procedure the gold standard in patients with persistent atrial fibrillation?

“…3) [19]. According to our previously mentioned recent experience [24,25], pulmonary vein gaps were detected in 12 of 24 patients who showed recurrent symptomatic atrial tachyarrhythmia after epicardial thoracoscopic ablation (Fig. 4).…”

“…The results of the current study are in accordance with our experiences in our institution. Among the 172 patients undergoing thoracoscopic ablation in our institution with a median follow-up duration of 1 year (Table 1) [24,25], patients suffered recurrent significant atrial tachyarrhythmia [24]. Additional catheter ablation was done on 22 of 24 patients and sinus rhythm was restored in 17 patients (Fig.…”

Catheter ablation of atrial arrhythmias in patients after thoracoscopic ablation of persistent atrial fibrillation

“…Авторы связывают наличие несостоятельности воздействий с недостаточностью РЧ-энергии на концах и в месте соединения электродов биполярного зажима. В исследование Hye Bin Gwag [14] Заключение У пациентов после процедуры торакоскопической аблации могут иметь место предсердные тахиаритмии, несмотря на эффективную изоляцию ЛВ. Причинами возникновения аритмий служат, как правило, несостоятельные линии аблации в местах повышенного эпикардиального жира.…”

Updates in hybrid AF ablation: a hybrid approach to surgical epicardial ablation and cather endocardial ablation in persistent atrial fibrillation

“…Non-PV related arrhythmias were confirmed in half of recurred patients. Gaps in right PVs were frequently noted at the posterior ridge [34].…”