scholarly journals P-175 Atrial fibrillation susceptibility is decreased after incomplete surgical ablation of the pulmonary veins

EP Europace ◽  
2003 ◽  
Vol 4 (Supplement_2) ◽  
pp. B108-B108
Author(s):  
T.J. van Brakel ◽  
G. Bolotin ◽  
L.W. Nifong ◽  
A.L. Dekker ◽  
T. van der Nagel ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Veins ◽  
Surgical Ablation

Intraoperative CARTO Mapping for Atrial Fibrillation Ablation in Patients Undergoing Cardiac Surgery

2021 ◽  
Author(s):  
Sara Rita Vacirca
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Heart Surgery ◽  
Pulmonary Veins ◽  
Open Heart Surgery ◽  
Atrial Fibrillation Ablation ◽  
Surgical Ablation ◽  
Before And After ◽  
The Mean ◽  
Exit Block

Objective: Intraoperative CARTO Mapping for Atrial Fibrillation ablation in cardiac surgery. Background: Surgical ablation of Atrial Fibrillation is usually performed without mapping. The study aims to determine if intraoperative CARTO can be useful to guide the ablating procedure. Methods and Findings: Fourteen patients with symptomatic and drug-refractory concomitant AF were operated on in 2003 and 2004. CARTO mapping was performed before and after surgical bipolar radio-frequency ablation. Application of energy was repeated when residual electrical activity was detected at the pulmonary veins-atrial junction. Pacing wires were applied on right and left pulmonary veins distally to the ablation line to confirm the exit block. The mapping protocol was completed in 12 patients. Acute left atrium-pulmonary vein isolation was achieved after single or double energy application in 2/12 (16.6%) and 9/12 (75%) patients, respectively. The mean duration of the mapping and ablation procedure was 67 minutes. At discharge, PV isolation persisted in 10 patients: exit block was confirmed by the absence of pacing through the pulmonary veins electrodes. After a mean follows up of 181 months, no further recurrent AF events were registered in 9/12 (69.2%) patients. Conclusions: CARTO system is useful during open-heart surgery to guide the ablating strategy.

scholarly journals Epicardial and Endocardial Validation of Conduction Block After Thoracoscopic Epicardial Ablation of Atrial Fibrillation

2020 ◽  
Vol 15 (6) ◽  
pp. 525-531
Author(s):  
Mindy Vroomen ◽  
Bart Maesen ◽  
Justin L. Luermans ◽  
Jos G. Maessen ◽  
Harry J. Crijns ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Catheter Ablation ◽  
Pulmonary Veins ◽  
Conduction Block ◽  
Epicardial Ablation ◽  
Surgical Ablation ◽  
Tissue Edema ◽  
Block Based ◽  
The Right ◽  
Positive Results

Objective It is unknown whether epicardial and endocardial validation of bidirectional block after thoracoscopic surgical ablation for atrial fibrillation is comparable. Epicardial validation may lead to false-positive results due to epicardial tissue edema, and thus could leave gaps with subsequent arrhythmia recurrence. It is the aim of the present study to answer this question in patients who underwent hybrid atrial fibrillation ablation (combined thoracoscopic epicardial and endocardial catheter ablation). Methods After epicardial ablation of the pulmonary veins (PVs) and connecting inferior and roof lines (box lesion), exit and entrance block were epicardially and endocardially evaluated using an endocardial His Bundle catheter and electrophysiological workstation. If incomplete lesions were found, endocardial touch-up ablation was performed. Validation results were also compared to predictions about conduction block based on tissue conductance measurements of the epicardial ablation device. Results Twenty-five patients were included. Epicardial validation results were 100% equal to the endocardial results for the left superior, left inferior, and right inferior PVs and box lesion. For the right superior PV, 85% similarity was found. Based on tissue conductance measurements, 139 lesions were expected to be complete; however, in 5 (3.6%) a gap was present. Conclusions Epicardial bidirectional conduction block in the PVs and the box lesion corresponded well with endocardial bidirectional conduction block. Conduction block predictions by changes in tissue conductance failed in few cases compared to block confirmation. This emphasizes that tissue conduction measurements can provide a rough indication of lesion effectiveness but needs endpoint confirmation by either epicardial or endocardial block testing.

scholarly journals Minimally Invasive Surgical Therapies for Atrial Fibrillation

2012 ◽  
Vol 2012 ◽  
pp. 1-12 ◽  
Author(s):  
Yoshitsugu Nakamura ◽  
Bob Kiaii ◽  
Michael W. A. Chu
Keyword(s):  
Atrial Fibrillation ◽  
Minimally Invasive ◽  
Left Atrial Appendage ◽  
Pulmonary Veins ◽  
Maze Procedure ◽  
Surgical Ablation ◽  
Minimally Invasive Surgical ◽  
Invasive Techniques ◽  
Lower Morbidity ◽  
Pharmacologic Therapies

Atrial fibrillation is the most common sustained arrhythmia and is associated with significant risks of thromboembolism, stroke, congestive heart failure, and death. There have been major advances in the management of atrial fibrillation including pharmacologic therapies, antithrombotic therapies, and ablation techniques. Surgery for atrial fibrillation, including both concomitant and stand-alone interventions, is an effective therapy to restore sinus rhythm. Minimally invasive surgical ablation is an emerging field that aims for the superior results of the traditional Cox-Maze procedure through a less invasive operation with lower morbidity, quicker recovery, and improved patient satisfaction. These novel techniques utilize endoscopic or minithoracotomy approaches with various energy sources to achieve electrical isolation of the pulmonary veins in addition to other ablation lines. We review advancements in minimally invasive techniques for atrial fibrillation surgery, including management of the left atrial appendage.

Subxiphoid left atrial ablation for atrial fibrillation

2020 ◽  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Pulmonary Veins ◽  
Structural Heart Disease ◽  
Term Treatment ◽  
Management Options ◽  
Lone Atrial Fibrillation ◽  
Surgical Ablation ◽  
Atrial Ablation ◽  
Long Term Treatment

Atrial fibrillation is becoming a disease that needs to be addressed with definitive long‐term treatment as opposed to medical management options. Ablation or isolation of focal triggers around the pulmonary veins can eliminate arrhythmia substrates for patients with paroxysmal, lone atrial fibrillation. However, limited pulmonary vein isolation strategies do not address reentrant circuits common in persistent and longstanding persistent patients with structural heart disease and enlarged atria. The convergent procedure is a hybrid ablation treatment for atrial fibrillation. It consists of surgical ablation of the posterior left atrium through a minimally invasive closed-chest approach followed by endocardial catheter ablation. The convergent procedure was developed to treat atrial fibrillation by creating a complete and comprehensive pattern of linear lesions on the left atrial backwall under direct endoscopic visualization while avoiding chest incisions and deflation of the lungs. Endocardial ablation follows the epicardial procedure to confirm lesion integrity and supplement the epicardial procedure, which is performed in a staged fashion.

scholarly journals Preoperative Noninvasive Mapping Allowed Targeted Concomitant Surgical Ablation and Revealed COVID-19 Infection

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Constantin Mork ◽  
Luca Koechlin ◽  
Matthias Streif ◽  
Alexa Hollinger ◽  
Martin Siegemund ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Mitral Valve ◽  
Pulmonary Veins ◽  
Persistent Atrial Fibrillation ◽  
Symptomatic Patient ◽  
Mitral Valve Insufficiency ◽  
Surgical Ablation ◽  
Urgent Surgery ◽  
Noninvasive Mapping ◽  
Pcr Test

In March 2020, a 64-year-old female with mitral valve insufficiency and persistent atrial fibrillation underwent preoperative noninvasive mapping for developing an ablation strategy. In the computed tomography (CT) scan, typical signs of COVID-19 were described. Since the consecutive polymerase chain reaction (PCR) test was negative, the severely symptomatic patient was planned for urgent surgery. Noninvasive mapping showed that atrial fibrillation was maintained by left atrial structures and pulmonary veins only. On admission day, the preoperative routine COVID-19 PCR test was positive, and after recovery, uneventful mitral valve repair with cryoablation of the left atrium and pulmonary veins was performed. Our case describes the potential benefit of preoperative noninvasive mapping for the development of a surgical ablation strategy, as well as the challenges in managing urgent surgical patients during the COVID-19 pandemic and the corresponding diagnostic relevance of CT.

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