Influence of Left Atrium Volume Index on effectiveness of Thoracoscopic Ablation in the Treatment of Atrial Fibrillation

Highlights. Stroke prevention in patients with atrial fibrillation is extremely important and difficult. Lifelong anticoagulant therapy is not always an effective way of preventing thrombosis in the left atrial appendage in this group of patients. In this regard, one of the most urgent problems of modern surgical arrhythmology and cardiac surgery is the search for new open and minimally invasive surgical methods of excluding the left atrial appendage from the blood flow.Aim. To investigate the safety and efficacy of using the left atrial appendage stapler for video-guided thoracoscopic ablation (TSA) of non-valvular atrial fibrillation (AF).Methods. The retrospective, single-center study included 100 patients with non-valvular AF who underwent video-guided thoracoscopic ablation of AF with single-stage left atrial appendage exclusion using an Endo GIA stapler (Medtronic, Minneapolis, Minnesota, USA).Results. The mean age of the patients was 56,2±8,8 years, the majority of the patients (73 patients, 73%) were male. Patients with persistent 50 (50%) AF and longstanding AF 50 (50%) were included in the study. The duration of atrial fibrillation was 4 (1,7–7) years. The median CHA2DS2-VASc and HAS-BLED scores were 2 (1–1,5) and 1 (0-1), respectively. The mean anticoagulation therapy-to-ablation time was 4,2±1,9 years. Thirty-eight (38%) patients were prescribed warfarin preoperatively. The completeness of left atrial appendage (LAA) exclusion was confirmed by intraoperative transesophageal echocardiography. The average length of the staple lines was 48 (35–75). A single left atrial appendage exclusion was performed using a 60 mm staples. In 12 (12%) patients, stapler exclusions were performed using two 45 mm staples due to insufficient staple length. None of the patients had ruptures, punctures along the staple lines or rupture of the surrounding epicardial tissue. Anticoagulant therapy was discontinued 6 months after TSA in 70 (70%) patients with sustained sinus rhythm observed on 24-h Holter Monitoring, satisfactory CHA2DS2-VASc scores and after confirmation of absence of left atrial thrombus by transesophageal echocardiography and contrast-enhanced MSCT. No strokes were reported within 1,2±0,7 years after discontinuing anticoagulation therapy.Conclusion. Exclusion of LAA using a stapler for TSA is a highly effective and safe technique for patients with non-valvular atrial fibrillation compared to alternative methods of excluding the LAA from the systemic blood flow.

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Left atrial appendage exclusion using a stapler with thoracoscopic ablation of atrial fibrillation

Revishvili

Kadirova

Стребкова

et al. 2023

Kompleks. probl. serdečno-sosud. zabol.

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Risk Factors for Atrial Tachyarrhythmia Recurrence in Patients With Non-Paroxysmal Atrial Fibrillation After «box Lesion Set» Thoracoscopic Ablation

Kadyrova,

Strebkova,

Yalova

et al. 2023

Kompleks. probl. serdečno-sosud. zabol.

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Highlights Identification of risk factors impacting the effectiveness of thoracoscopic ablation according to the box session set scheme will allow us to formulate criteria for the selection of patients with non-paroxysmal atrial fibrillation for epicardial ablation of the left atrium.Duration of atrial fibrillation for more than 7.5 years and the volume of the left atrium indexed to the body surface area of more than 47 mL/m2 statistically significantly reduce the effectiveness of thoracoscopic ablation of stable atrial fibrillation by 34.2 and 55.8% during the three-year follow-up period, respectively.The need to assess the function of left atrium using modern two-dimensional speckle-tracking echocardiography technology should be considered to determine the criteria for the successful ablation of non-paroxysmal atrial fibrillation. The aim. To study risk factors for atrial tachyarrhythmias recurrence after thoracoscopic ablation (TSA) of non-paroxysmal atrial fibrillation (AF) in the long-term follow-up period.Methods. The retrospective study included a series of 100 patients with non-paroxysmal AF undergoing “Box lesion set” TSA with one-stage exclusion of the left atrial (LA) appendage. The efficacy of TSA in the long-term follow-up period was evaluated using 24-h HM ECG results. A retrospective analysis of risk factors for atrial tachyarrhythmias recurrence after TSA was performed. The analysis included the main clinical characteristics of patients in the preoperative period, as well as data of transthoracic echocardiography with inclusion of left atrial strain in the reservoir and conduit phases.Results. In the presented study, the main risk factors for atrial tachyarrhythmias recurrence after TSA were: duration of AF more than 7.5 years and LAVI more than 47 mL/m2. However, univariate analysis showed that for every 1-year increase in the duration of AF, the risk of arrhythmia recurrence after TSA increased 1.07-fold [95% CI: 1.01; 1.17, p = 0.0374], and for every 10 mL/m2 increase in LAVI, the risk of atrial tachyarrhythmia recurrence increased 1.95-fold [95% CI: 1.49; 2.56, p<0.001]. According to the data of two-dimensional speckle-tracking echocardiography there was a tendency towards the decrease of the parameters of left atrial strain in the reservoir phase mainly in patients with AF, which requires further more detailed study on a larger cohort of patients.Conclusion. It is necessary to consider not only the assessment of the anatomy of the left atrium, but its function with the use of modern methods of radial imaging at the preoperative stage in order to improve the effectiveness of TSA “Box lesion set” for non-paroxysmal AF in the long-term follow-up period.

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Modern methods of echocardiographic assessment of the functional status of the left atrium in atrial fibrillation

Kadirova,

Yalova,

Shebzuhova

et al. 2023

Medicinskaâ vizualizaciâ

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Atrial fibrillation (AF) is the most common cardiac arrhythmia, accompanied by significant morbidity and mortality among the entire population. In AF, it is the left atrium (LA) that is considered as a critical indicator of the development of adverse cardiovascular events. LA dilation followed by electrophysiological remodeling is a frequent observation in patients with AF.Thus, echocardiography (EchoCG) is of particular interest, in particular, the use of two-dimensional and threedimensional Speckle tracking echocardiography (STE) to study the morphofunctional state of LA at the patient's bedside.Currently, several major lecture reviews on echocardiographic assessment of LA function are presented in the domestic literature, but individual methods of radiation imaging and their correlation with each other have not been studied, there are only a couple of foreign meta-analyses on the assessment and analysis of the functional state of LA in patients with AF. This problem is relevant, since the establishment of predictors of AF at an early stage, in particular with its latent course, makes it possible to prevent the development of a number of complications associated with arrhythmia from ischemic strokes to sudden cardiac death.The purpose of this literature review is to present the data of recent studies on the assessment of the structure and function of LA using STE to identify patients with asymptomatic AF or a high risk of its recurrence after ablation procedures.

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Influence of Left Atrium Volume Index on effectiveness of Thoracoscopic Ablation in the Treatment of Atrial Fibrillation

Cited by 5 publications

References 34 publications

Left atrial appendage exclusion using a stapler with thoracoscopic ablation of atrial fibrillation

Left atrial appendage exclusion using a stapler with thoracoscopic ablation of atrial fibrillation

Risk Factors for Atrial Tachyarrhythmia Recurrence in Patients With Non-Paroxysmal Atrial Fibrillation After «box Lesion Set» Thoracoscopic Ablation

Modern methods of echocardiographic assessment of the functional status of the left atrium in atrial fibrillation

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