Turnstile left atrial appendage occlusion during thoracoscopic ablation

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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Recurrence of Arrhythmias after Thoracoscopic MAZE procedure

Lyashenko,

Ivanchenko,

Postol

et al. 2023

Cardiac Arrhythmias

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BACKGROUND: Thoracoscopic version of the MAZE operation alone or in combination with catheter ablation (hybrid approach) has become widespread in the treatment of atrial fibrillation (AFib). However, recurrences of arrhythmias after such operations, in particular recurrence of AFib, remain unresolved problem. AIM: The aim of this study was to establish the structure of arrhythmia recurrence in patients with long-standing persistent AFib after primary epicardial ablation using the Dallas lesion set technique, as well as determining the optimal RFA strategy for recurrence. METHODS: 138 catheter ablation procedures for 100 patients, who applied with recurrence of various atrial arrhythmias after thoracoscopic MAZE. 34 patients had 2 or more RFA (31 pts 2, 2 pts 3, 1 pts 4). RESULTS: After Dallas lesion set thoracoscopic ablation in the structure of recurrences dominated: 1 AFib recurence; 2 incisional left atrial flutter. After the operation, a potential arrhythmogenic substrate remains, which must be fully eliminated by RFA (in addition to ablation the main cause of recurrence). This minimally necessary intervention implies: control and reisolation of the pulmonary veins; control and reisolation of the posterior wall; septal line from the mitral valve to the right superior pulmonary vein with Y-shaped branch to the left superior pulmonary vein; cava-tricuspid isthmus-blockade. This will eliminate and prevent in the future potentially possible incisional arrhythmias in fragmentary scars after thoracoscopic MAZE procedure. The return of AFib represents the most difficult group of patients. Restoration of sinus rhythm in recurrent AFib after epicardial ablation is possible, but may require extensive ablations in both atriums, as a result of repeated procedures, until all potential arrhythmia mechanisms, present in a particular patient, are eliminated. CONCLUSIONS: Catheter ablation remains the only method of effective treatment of recurrences after thoracoscopic MAZE procedure. The complexity and multicomponent nature of long-standing AFib causes the frequent need for repeated procedures, especially in cases of recurrence of atrial fibrillation.

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Electrophysiological mechanisms of arrhythmias after thoracoscopic Maze procedure

Lyashenko

Иванченко

Постол

et al. 2020

Vestnik aritmologii

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Объект исследования: комбинация торакоскопической эпикардиальной аблации с последующими катетерными процедурами является современным и эффективным подходом для лечения длительно-персистирующей фибрилляции предсердий (ДПФП). Учитывая стандартную методику эпикардиальной аблации, дизайн которой зависит, в основном, от использованных инструментов и технологий, последующая катетерная аблация должна устранять все типичные слабые места эпикардиального этапа. Целью данного исследования явилось установить основные причины рецидивов предсердных аритмий у пациентов с ДПФП после первичной эпикардиальной аблации по методике Dallas lesion set. Методы: торакоскопическая аблация была проведена 330 пациентам, выполнялась стандартная биполярная изоляция устьев легочных вен (ЛВ) и монополярные линейные воздействия для изоляции задней стенки левого предсердия (ЗСЛП) (AtriCure Inc.). 47 из них в связи с рецидивом различных предсердных аритмий был проведен второй эндокардиальный этап электрофизиологического исследования и радиочастотная аблация (РЧА), с подавляющим большинством повторных процедур в сроки 3-6 месяцев. В протокол проведения эндокардиальной РЧА, помимо картирования и устранения основной причины рецидива (предсердная тахикардия, трепетание предсердий или ФП), входил контроль изоляции ЛВ и ЗСЛП. Результаты: проведенное исследование продемонстрировало, что после торакоскопической аблации по методике Dallas lesion set у пациентов с рецидивами предсердных аритмий: 1) часто необходима реизоляция ЗСЛП (типичной зоной восстановления проведения является крыша ЛП, однако, возможны и редкие варианты проведения через заднее соустье правых ЛВ); 2) после эпикардиальной аблации крыши ЛП монополярным электродом формируется широкий негомогенный рубец с многочисленными зонами медленного проведения, низкоамплитудными, фрагментированными сигналами, не доходящий до митрального клапана, этот рубец-основная причина инцизионных трепетаний; 3) как причина рецидива аритмии возможны дополнительные драйверы ФП, не охваченные дизайном эпикардиальной аблации-эктопические / микро re-enrty предсердные тахикардии, различные аритмии из правого предсердия. Выводы: катетерная аблация после торакоскопической процедуры MAZE позволяет устранить имеющиеся недостатки эпикардиальных линий и дополнить их воздействием на механизмы поддержания ФП, уникальные для конкретного пациента. Ключевые слова: радиочастотная аблация, фибрилляция предсердий, торакоскопическая аблация, гибридный подход, рецидив фибрилляции предсердий, лечение длительно-персистирующей фибрилляции предсердий. Конфликт интересов: авторы заявляют об отсутствии потенциального конфликта интересов, требующего раскрытия в данной статье.

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Turnstile left atrial appendage occlusion during thoracoscopic ablation

Cited by 3 publications

References 7 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

Recurrence of Arrhythmias after Thoracoscopic MAZE procedure

Electrophysiological mechanisms of arrhythmias after thoracoscopic Maze procedure

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