Mid-Term Results of Totally Thoracoscopic Ablation in Patients with Recurrent Atrial Fibrillation after Catheter Ablation

Lim, Suk Kyung; Kim, Joo Yeon; On, Young Keun; Jeong, Dong Seop

doi:10.5090/kjtcs.19.059

Cited by 11 publications

(10 citation statements)

References 20 publications

(25 reference statements)

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“…In our center, a minimally invasive video-assisted thoracoscopic surgery (VATS) began to be actively utilized in March 2010 for epicardial ablation of atrial fibrillation or implantation of LV leads, avoiding more invasive median sternotomy or full thoracotomy [ 8 , 11 , 12 ]. In the present study, we sought to evaluate the acute and post-discharge safety and effectiveness of epicardial LV lead implantation using VATS.…”

Section: Introductionmentioning

confidence: 99%

Thoracoscopic Implantation of Epicardial Left Ventricular Lead for Cardiac Resynchronization Therapy

Kim

Lim

Park

et al. 2022

JCDD

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(1) Background: Limited data exist on the safety and efficacy of epicardial left ventricular (LV) lead placement using video-assisted thoracoscopic surgery (VATS) for cardiac resynchronization therapy (CRT). (2) Methods: Acute and post-discharge outcomes of CRT were compared between patients with epicardial LV leads (Epicardial-LV group, n = 13) and those with endocardial LV leads (Endocardial-LV group, n = 243). (3) Results: Epicardial LV leads were implanted via VATS alone (n = 8) or along with mini-thoracotomy (n = 5), for failed endocardial implantation (n = 11) or recurrent lead dislodgement (n = 2). All epicardial procedures under general anesthesia with one-lung ventilation were successfully completed in 1.0 ± 0.4 h without phrenic nerve stimulation. LV pacing thresholds in the epicardial-LV (1.5 ± 1.0 V) and endocardial-LV (1.3 ± 0.8 V) were comparable (p = 0.651). All patients were discharged alive post-VATS 8.8 ± 3.9 days. During the follow-up (34.3 ± 28.6 months), all patients with epicardial LV leads stayed alive except for one cardiac death post-CRT 14 months and one heart transplantation post-CRT 30 months. All epicardial LV leads maintained stable performance without dislodgement/significant changes in pacing threshold/impedance. LV lead dislodgement occurred only in endocardial-LV (7/243, 2.9%). Efficacy in both groups was comparable in terms of QRS narrowing, increase in LV ejection fraction, and survival free of cardiac death, or heart-failure-related hospitalization. (4) Conclusions: Epicardial LV lead placement using VATS can be a safe and effective alternative to endocardial implantation, with comparable acute and post-discharge outcomes achieved by both approaches.

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Section: Introductionmentioning

confidence: 99%

Thoracoscopic Implantation of Epicardial Left Ventricular Lead for Cardiac Resynchronization Therapy

Kim

Lim

Park

et al. 2022

JCDD

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“…The maze procedure for patients with unsuccessful catheter ablation achieves a return to sinus rhythm more frequently than additional catheter ablation [ 73 , 89 ]. Thoracoscopic ablation for recurrent AF in patients with previous catheter ablation was also effective in a matched cohort analysis [ 90 ].…”

Section: Discussionmentioning

confidence: 99%

2023 KASNet Guidelines on Atrial Fibrillation Surgery

Je,

Choi,

Hwang

et al. 2023

J Chest Surg

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“…The indications for TTA also included refractory symptom, history of stroke, or intolerance for anticoagulant therapy. TTA was contraindicated in patients with LA thrombi or who were intolerant of one-lung ventilation ( 15 , 16 ).…”

Section: Methodsmentioning

confidence: 99%

Left atrial strain predicts fibrosis of left atrial appendage in patients with atrial fibrillation undergoing totally thoracoscopic ablation

Kim

Park

Jeong

et al. 2023

Front. Cardiovasc. Med.

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BackgroundLeft atrial (LA) fibrosis is related with development and severity of atrial fibrillation (AF). The aim of this study was to investigate the association between LA strain and LA fibrosis in patients undergoing totally thoracoscopic ablation (TTA) for AF.MethodsBetween February 2012 and March 2015, a total of 128 patients who underwent TTA were enrolled from a tertiary hospital. Left atrial appendage (LAA) was harvested during surgery to determine the degree of fibrosis. LAA fibrosis was classified as mild (1st quartile), moderate (2nd and 3rd quartile), or severe (4th quartile). Clinical outcome was 5-year recurrence rate of AF detected on electrocardiogram or 24 h Holter monitoring.ResultsThe mean age was 54.3 ± 8.8 years and 18.8% had paroxysmal AF. Patients with mild LAA fibrosis had a significantly lower rate of recurrent AF (23.3%) at 5 years after TTA compared with those with moderate (51.4%; hazard ratio [HR] 2.69; 95% confidence interval [CI] 1.19–6.12) or severe (53.2%; HR 2.84; 95% CI 1.16–6.97) fibrosis. Among clinical and echocardiographic parameters, peak LA strain was the only predictor of mild LAA fibrosis (coefficient 0.10, p = 0.005) with the best cutoff value of 14.7% (area under the curve 0.732). The prevalence of mild LAA fibrosis was 40.6% in patients with peak LA strain ≥14.7%, but only 6.8% in those with peak LA strain <14.7%.ConclusionsIn patients undergoing TTA for AF, mild LAA fibrosis was associated with a lower risk of 5-year AF recurrence. LA strain was the only predictor of mild LAA fibrosis that reflects a lower risk of 5-year AF recurrence.

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Mid-Term Results of Totally Thoracoscopic Ablation in Patients with Recurrent Atrial Fibrillation after Catheter Ablation

Cited by 11 publications

References 20 publications

Thoracoscopic Implantation of Epicardial Left Ventricular Lead for Cardiac Resynchronization Therapy

Thoracoscopic Implantation of Epicardial Left Ventricular Lead for Cardiac Resynchronization Therapy

2023 KASNet Guidelines on Atrial Fibrillation Surgery

Left atrial strain predicts fibrosis of left atrial appendage in patients with atrial fibrillation undergoing totally thoracoscopic ablation

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