Atrial Remodelling: What Have We Learned in the Last Decade?

Abstract Background Surgical epicardial AF ablation can be performed as a stand-alone (thoracoscopic) procedure or concomitant to other cardiac surgery. In hybrid AF ablation thoracoscopic surgical epicardial ablation is combined with a percutaneous endocardial ablation. The Medtronic Gemini-S clamp is a surgical tool that uses irrigated bipolar biparietal RF energy applied with two clamp lesions that overlap to create one epicardial box lesion including the posterior LA wall and the pulmonary veins. Case summary We describe three patients with therapy-refractory persistent AF and different stages of atrial remodelling in whom the Medtronic Cardioblate Gemini-S Irrigated RF Surgical Ablation System was used for hybrid AF ablation. Acute endocardial validation at the end of the hybrid ablation revealed a complete box lesion in all three cases. At 2-year follow-up, two out of three patients had recurrence of atrial arrhythmias. Invasive electro-anatomical mapping confirmed persistence of the box lesion, and the mechanism of arrhythmia recurrence in both patients was unrelated to posterior left atrium or the pulmonary veins. The third patient has been without arrhythmia symptoms since the ablation procedure. A 3D late gadolinium enhancement (LGE) magnetic resonance imaging (MRI) illustrates the ablation scar non-invasively in two cases. Discussion Thoracoscopic biparietal RF AF ablation with the Medtronic Cardioblate Gemini-S Irrigated RF Surgical Ablation System results in permanent transmural scar formation, irrespective of the stage of atrial remodelling, as shown in this small population by means of multimodality scar evaluation.

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A case report: cardiac dysphagia — a ghost of the past?

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab338 ◽

2021 ◽

Author(s):

Céline Deschepper ◽

Daniel Devos ◽

Michel De Pauw

Keyword(s):

Mitral Valve ◽

Left Atrium ◽

Pressure Overload ◽

Developed Countries ◽

Extrinsic Compression ◽

Oesophagogastric Junction ◽

Atrial Remodelling ◽

History Of ◽

Giant Left Atrium ◽

Mitral Disease

Abstract Background Rheumatic heart disease has become rare in developed countries and physicians have grown unfamiliar with the disease and its clinical course. The mitral valve is most commonly affected leading to mitral regurgitation and/or stenosis. The chronic volume and/or pressure overload leads to atrial remodelling and enlargement, driving the development of atrial fibrillation and thromboembolic events. Case Summary A 87-year-old patient with a history of rheumatic mitral stenosis and mitral valve replacement was admitted to the neurology department for vertigo. A stroke was suspected and she underwent a transoesophageal echocardiogram which was complicated by dysphagia. Oesophageal manometry and CT revealed oesophagogastric junction outflow obstruction due to extrinsic compression by a giant left atrium. Discussion Dysphagia due to a giant left atrium is rare. Various diagnostic criteria exist and the prevalence thus depends on which criterium is used. It is mostly encountered in rheumatic mitral disease, although there are reports of non-rheumatic etiology. When the left atrium assumes giant proportions it can compress adjacent intrathoracic structures. Compression of the oesophagus can lead to dysphagia, as in our case. A transoesophageal echocardiogram in these cases is relatively contraindicated and should only be performed if there is considerable reason to believe that it may change patient management.

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