Minimally Invasive Radiofrequency Ablation of Lone Atrial Fibrillation by Monolateral Right Minithoracotomy: Operative and Early Follow-Up Results

Saglio, Giuseppe; Bonifazi, Raffaele; Nasso, Giuseppe; Bartolomucci, Francesco; Caldarola, Pasquale; Fattouch, Khalil; Martines, Giuseppe Fabio; Tavazzi, Luigi; Chierchia, Sergio Luigi

doi:10.1016/j.athoracsur.2010.03.057

Cited by 20 publications

(32 citation statements)

References 12 publications

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“…Surgical ablations that de-connect a large part of the posterior left atrium, where many of the sources of the PeAF are located, have also become increasing used owing to their simple approach. Conversely, surgical procedures also are difficult to evaluate, and numerous observational studies of mixed populations without controls used different sources of energy and line combinations [15,17,18]. …”

Section: Discussionmentioning

confidence: 99%

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Staged transthoracic approach to persistent atrial fibrillation (TOP-AF): study protocol for a randomized trial

Pragliola

Mastroroberto

Gaudino

et al. 2014

Trials

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BackgroundPersistent atrial fibrillation frequently shows multiple different electrophysiological mechanisms of induction. This heterogeneity causes a low success rate of single procedures of ablation and a high incidence of recurrence. Surgical ablation through bilateral thoracotomy demonstrates better results after a single procedure. Prospective observational studies in inhomogeneous populations without control groups report a remarkable 90% of success with hybrid or staged procedures of surgical ablation coupled with catheter ablation. In this trial, we will examine the hypothesis that a staged approach involving initial minimally invasive surgical ablation of persistent atrial fibrillation, followed by a second percutaneous procedure in case of recurrence, has a higher success rate than repeated percutaneous procedures.Methods/DesignThis is a controlled (2:1) randomized trial comparing use of a percutaneous catheter with minimally invasive transthoracic surgical ablation of persistent atrial fibrillation. The inclusion and exclusion criteria, definitions, and treatment protocols are those reported by the 2012 Expert Consensus Statement on catheter and surgical ablation of atrial fibrillation. Patients will be randomized to either percutaneous catheter (n = 100) or surgical (n = 50) ablation as the first procedure. After 3 months, they are re-evaluated, according to the same guidelines, and receive a second procedure if necessary. Crossover will be allowed and data analyzed on an “intention-to-treat” basis. Primary outcomes are the incidence of sinus rhythm at 6 and 12 months and the proportions of patients requiring a second procedure.DiscussionThe use of a staged strategy combining surgical and percutaneous approaches might be more favorable in treatment of persistent atrial fibrillation than the controversial single percutaneous ablation.Trial registrationISRCTN08035058 Reg 06.20.2013

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Section: Discussionmentioning

confidence: 99%

“…The ablation procedure will be performed with the use of Estech cobra fusion, according to the manufacturer’s instructions and to the commonly described techniques [10,12,15]. Up to three applications will be allowed to ablate the left atrial box.…”

Section: Methodsmentioning

confidence: 99%

Staged transthoracic approach to persistent atrial fibrillation (TOP-AF): study protocol for a randomized trial

Pragliola

Mastroroberto

Gaudino

et al. 2014

Trials

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“…Pulmonary Vein Isolation (PVI) alone has been performed by a number of groups and has produced good results in paroxysmal AF; however the results in longstanding AF have been suboptimal with significantly higher recurrence rates reported [31–34]. Several small studies report freedom from AF after RF PVI ranging from 87% at 6 months [31] and 71% at 3.3-year mean followup [35].…”

Section: Radiofrequency Ablationmentioning

confidence: 99%

“…Several small studies report freedom from AF after RF PVI ranging from 87% at 6 months [31] and 71% at 3.3-year mean followup [35]. When combined with left atrial appendage (LAA) excision, ligament of Marshall (LoM) or ganglionic plexus ablation, PVI has yielded rates of freedom from AF ranging from 87–87.5% at 6 months [31, 32] and 65% at 1-year followup [36]. …”

Section: Radiofrequency Ablationmentioning

confidence: 99%

“…As such, it is difficult to produce uniform settings for each instrument and the need for feedback to confirm transmurality remains important. Whilst some of these groups report the use of impedance measurements or entry and exit stimulation as confirmatory mechanisms [36, 37] others lack any form of feedback [31, 35, 38]. It is also possible that even in the presence of complete transmurality early postoperative reinnervation of the myocardium may precipitate AF recurrence.…”

Section: Radiofrequency Ablationmentioning

confidence: 99%

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Strategies in the Surgical Management of Atrial Fibrillation

Harling

Athanasiou

Ashrafian

et al. 2011

Cardiology Research and Practice

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Atrial fibrillation (AF) is associated with substantial morbidity, mortality, and economic burden and confers a lifetime risk of up to 25%. Current medical management involves thromboembolism prevention, rate, and rhythm control. An increased understanding of AF pathophysiology has led to enhanced pharmacological and medical therapies; however this is often limited by toxicity, variable symptom control, and inability to modulate the atrial substrate. Surgical AF ablation has been available since the original description of the Cox Maze procedure, either as a standalone or concomitant intervention. Advances in novel energy delivery systems have allowed the development of less technically demanding procedures potentially eliminating the need for median sternotomy and cardiopulmonary bypass. Variations in the definition, duration, and reporting of AF have produced methodological limitations impacting on the validity of interstudy comparisons. Standardization of these parameters may, in future, allow us to further evaluate clinical endpoints and establish the efficacy of these techniques.

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