Position of Totally Thoracoscopic Surgical Ablation in the Treatment of Atrial Fibrillation: An Alternative Method of Conduction Testing

Abstract

Recent advances in surgical techniques and understanding of the pathophysiology of atrial fibrillation has led to the development of a less invasive thoracoscopic surgical treatment including video-assisted bilateral pulmonary vein isolation using bipolar radiofrequency ablation clamps. More recently, the same operation became possible via a totally thoracoscopic approach.In this paper we describe technical aspects of the thoracoscopic approach to surgical treatment of AF and discuss its features, benefits and limitations. Furthermore, we present a new alternative technique of conduction testing using endoscopic multi-electrode recording catheters.An alternative electrophysiological mapping strategy involves a multi-electrode recording catheter designed primarily for percutaneous endocardial electrophysiologic mapping procedure. According to our initial experience, the recordings obtained from the multi-electrode catheters positioned around the pulmonary veins are more accurate than the recordings obtained from the multifunctional ablation and pacing pen.The totally thoracoscopic surgical ablation approach is a feasible and efficient treatment strategy for atrial fibrillation. The conduction testing can be easily and rapidly performed using a multifunctional pen or multi-electrode recording catheter.

Haematological indices as predictors of atrial fibrillation following isolated coronary artery bypass grafting, valvular surgery, or combined procedures: a systematic review with meta-analysis

“…New postoperative atrial fibrillation (POAF) is one of the most critical and common complications after cardiovascular surgery, precipitating early and late morbidities such as cardiovascular events, thromboembolism, cerebrovascular events, prolonged hospital stay and readmissions to the intensive care unit (ICU) and hospital, organ failure, as well as increased health care costs and mortality [1][2][3]. Atrial fibrillation (AF) is a hazardous and widespread complication following coronary artery bypass graft (CABG), with an incidence of 20% to 50%, and with incidence peaks occurring two to three days after surgery [1][2][3]. The pathophysiological mechanism of AF is highly complex and is affected by diverse factors, and a variety of diagnostic modalities have been shown to be useful in predicting or diagnosis of POAF [4,5].…”

Underexpression of CACNA1C Caused by Overexpression of microRNA-29a Underlies the Pathogenesis of Atrial Fibrillation

“…Encoded by CACNA1C gene, protein CaV1.2 is a1-subunits of cardiac L-type calcium channel (LTCC) and comprises the ion permeating subunit, which determines the main pharmacological and biophysical properties of the channel [ 31 ]. A consistent reduction of I Ca,L density has been observed in in AF experimental models as well as in CAF patients [ 32 ], and it is believed that the process was triggered by Ca 2+ overload secondary to the rapid atrial rates [ 33 ]. The molecular mechanisms underlying I Ca,L downregulation are complex and may include impaired Cav1.2 protein trafficking induced by impaired Src kinase activity, ankyrin-B dysfunction, ankyrin-B dysfunction, enhanced Cav1.2 α-subunit S-nitrosylation, Ca 2+ channel dephosphorylation because of serine/threonine protein phosphatase activation, Ca 2+ channel dephosphorylation because of serine/threonine protein phosphatase activation, activation of the Ca 2+ /calmodulin/calcineurin/nuclear factor of activated T cells system, causing transcriptional downregulation of the Cav1.2 α-subunit or a zinc-binding protein [ 7 , 34 – 36 ].…”

Optimization of minimally invasive approach in the surgical ablation of accessory atrio-ventricular pathways in open heart

“…В настоящий момент малоинвазивные методики получили широкое распространение в ле-чении целого спектра кардиохирургических патологий. Так, в последние годы в передовых клиниках мира применяется торакоскопический доступ в устранении фибрилляции предсердий [20]. По данным современных публикаций, торакоскопический хирургический подход к аблации является возможной и эффективной стратегией лечения ФП [21].…”

“…В контексте темы нашей работы мы приводим подробное описание хирургического доступа и техники процедуры торакоскопической изоляции легочных вен, описанной в статье A. Sabashnikov et al [20]. Вмешательство проводят под общей газово-медикаментозной седацией, вентиляцию -посредством эндотрахеальной трубки.…”