Surgical Treatment of Atrial Fibrillation

Wolf, Randall K.

doi:10.14797/vndg5944

Cited by 5 publications

(5 citation statements)

References 28 publications

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“…As reported by Wolf ( 13 ), the sinus rhythm conversion rate of minimally invasive maze surgery can be as high as 91.4%. Furthermore, it does not require a median thoracotomy, which greatly reduces surgical trauma, while retaining the efficiency and safety of AF surgical treatment.…”

Section: Discussionmentioning

confidence: 79%

Clinical effect of total thoracoscopic mitral valve surgery combined with atrial fibrillation radiofrequency ablation in patients with different left atrium diameter—a single center prospective observational cohort study

Yao¹,

Zhang²,

Li³

et al. 2022

J Thorac Dis

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Background Mitral valve surgery combined with atrial fibrillation (AF) radiofrequency ablation (AFRA) is recommended as the first-line strategy for valvular disease-related AF. There are relatively few reports on the effect of AFRA combined with total thoracoscopic mitral valve surgery. This article aimed to analyze the clinical data and prognostic outcomes of patients with diverse left atrium diameter (LAD) (>50 or ≤50 mm) who underwent total thoracoscopic mitral valve surgery combined with AFRA. Methods We conducted a prospective analysis of patients who underwent AFRA from January 2021 to June 2022 in the Department of Cardiovascular Surgery at the Chinese PLA General Hospital. The inclusion criteria were: (I) aged 40–70 years; (II) diagnosed with valvular heart disease and concomitant long-term persistent AF (>1 year); (III) patients who underwent total thoracoscopic mitral valve surgery; (IV) with a left ventricular end-diastolic diameter of ≤70 mm; (V) with a LAD ≤65 mm; and (VI) left ventricular ejection fraction (LVEF) ≥50%. The included patients were assigned to group A and B depend up on the LAD. All patients were followed up at 3 and 6 months timepoints postoperatively. The prime endpoint was the recovery rate of sinus rhythm. Results There were 24 cases in group A (LAD >50 mm) and 16 cases in group B (LAD ≤50 mm). The two groups exhibited no statistical differences in terms of age, gender proportion, preoperative comorbidities, AF duration, preoperative heart function, and type of valve disease (P>0.05). The LAD, pulmonary artery pressure, and left ventricular diameter of group A were significantly greater than those of group B (P<0.05). There were no new cerebrovascular incidents during the perioperative and follow-up periods. The sinus rhythm conversion rates in group A after surgery and at 6 months were 75% and 66.7%, respectively; meanwhile, both of these values were 87.5% in group B, and the difference between the groups was statistically significant (P<0.05). Conclusions Total thoracoscopic mitral valve surgery with AFRA is more effective in maintaining sinus rhythm in patients with LAD ≤50 mm than in those with LAD >50 mm without increased risk of adverse events. Further studies are warranted to validate our findings.

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Section: Discussionmentioning

confidence: 79%

Clinical effect of total thoracoscopic mitral valve surgery combined with atrial fibrillation radiofrequency ablation in patients with different left atrium diameter—a single center prospective observational cohort study

Yao¹,

Zhang²,

Li³

et al. 2022

J Thorac Dis

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“…Therefore, several minimally invasive techniques have been developed to replicate the results of the Cox maze procedure, avoiding cardiopulmonary bypass and reducing morbidity and complexity [ 17 , 18 , 19 ].…”

Section: Discussionmentioning

confidence: 99%

Robotic-Assisted Epicardial Hybrid Ablation and Left Appendage Closure in Persistent Atrial Fibrillation: First European Experience

Agnino,

Giroletti,

Graniero

et al. 2024

JCM

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Background: Pulmonary vein isolation is currently considered to be the gold standard for ablating paroxysmal atrial fibrillation. However, its efficacy is limited in patients with persistent atrial fibrillation. The convergent procedure has emerged as a hybrid ablation. This study aims, for the first time in the literature, to introduce a hybrid approach that includes epicardial ablation with cutting-edge robotic technology and subsequent electrophysiological study to verify and an endocardial ablation to complete the ablation lines. Methods: We present 18 cases of robotic-assisted epicardial hybrid ablation performed between April and December 2023 on patients with long-standing persistent atrial fibrillation (mean age: 64 ± 5 years; mean duration: 4 ± 2 years). All of the procedures were performed at “Humanitas Gavazzeni Hospital”, Bergamo, Italy. Robot-assisted epicardial ablation performed using the “Epi-Sense AtriCure” device was guided by monitoring electrogram morphology and point-by-point impedance drop. This approach also included left atrial appendage occlusion and the disconnection of the ligament of Marshall. An electrophysiological study and endocardial ablation were planned three months after the procedure. Results: The procedure was successfully executed in all patients with no major complications and a mean operative time of 142 ± 22 min. None of the cases required conversion to full sternotomy or minithoracotomy. The procedure was performed in all cases without extracorporeal circulation and on a beating heart. Fifteen patients (83%) were extubated in the operating room. The length of stay in the intensive care unit was less than 24 h. Acute restoration of sinus rhythm was achieved in 12 out of the 18 patients (67%); the median duration of their hospital stay was two days. In the electrophysiological study, seven pts had sinus rhythm, two had atrial fibrillation, and one patient developed atrial flutter at 3-month follow-up. Patients underwent transcatheter ablation to complete the lesion set and, at the time of discharge, were all in sinus rhythm. Conclusions: In our initial experience, surgical atrial fibrillation ablation consisting of a unilateral thoracoscopic technique facilitated by a robotic platform and continuous EGM monitoring has proven to be safe and feasible. For the electrophysiological study at 3 months, completing the gaps in the surgical ablation lines could improve the clinical results of the technique in terms of sinus rhythm stability. However, mid- and long-term follow-up is required to demonstrate this.

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“…44 The Wolf mini-maze procedure includes video-assisted thoracoscopic PV isolation, ganglionated plexi ablation and LAA closure. 45 The two procedural terms are sometimes used interchangeably, however, one difference in the approaches is that the mini-maze procedure uses 5-6 cm bilateral incisions for working ports whereas the TT maze procedure uses smaller bilateral working ports. 45 Tricuspid and mitral valve annulus lesions that are usually made with cryoablation in the Cox maze IV procedure are not created with these epicardial approaches.…”

Section: Thoracoscopic Ablationmentioning

confidence: 99%

A Chronicle of Hybrid Atrial Fibrillation Ablation Therapy: From Cox Maze to Convergent

Kaba

Ahmed

Behr

et al. 2022

Arrhythm Electrophysiol Rev

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The burden of AF is increasing in prevalence and healthcare resource usage in the UK and worldwide. It can result in impaired quality of life for affected patients, as well as increased risk of stroke, heart failure and mortality. A holistic, integrated approach to AF management is recommended, which may include a focus on reducing risk factors and on medical management with anticoagulation and anti-arrhythmic drugs. There are also various ablation strategies that may be considered when anti-arrhythmic drugs fail to alleviate symptoms and reduce AF burden. These ablation techniques range from standalone percutaneous endocardial catheter ablation to open surgical ablation procedures concomitant with cardiac surgery. More recently, hybrid ablation that combines aspects of both surgical and electrophysiologically targeted ablation has been described. This article reviews the evolution of ablation strategies, beginning with the origin of the Cox maze IV procedure and continuing to the recent hybrid convergent approach, and provides a summary of the associated outcomes.

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Surgical Treatment of Atrial Fibrillation

Cited by 5 publications

References 28 publications

Clinical effect of total thoracoscopic mitral valve surgery combined with atrial fibrillation radiofrequency ablation in patients with different left atrium diameter—a single center prospective observational cohort study

Clinical effect of total thoracoscopic mitral valve surgery combined with atrial fibrillation radiofrequency ablation in patients with different left atrium diameter—a single center prospective observational cohort study

Robotic-Assisted Epicardial Hybrid Ablation and Left Appendage Closure in Persistent Atrial Fibrillation: First European Experience

A Chronicle of Hybrid Atrial Fibrillation Ablation Therapy: From Cox Maze to Convergent

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