Is balloon cryoablation effective in common pulmonary trunk?

Abstract Introduction Common pulmonary trunk (CPT) accounts for the most frequent pulmonary vein anatomical variation. The most frequent technique used for pulmonary vein isolation (PVI) is point-by-point radiofrequency, using cryoablation (CB) is still debatable. Some few studies have shown the feasibility and safety of CB in CPT atrial fibrillation (AF) patients (pts), most of them performed angio-CT prior to ablation. Purpose To analyzed AF pts with and without CPT submitted to CB in regarding of success rate and safety. Methods Single-center retrospective study of consecutive AF pts refractory to antiarrhythmics submitted to CB between 2017 and 2020. Before the procedure auriculography was performed in all pts to verify variations in pulmonary veins, however the procedure was not modify regarding the presence of CPT. Clinical records were analyzed to determine baseline characteristics, success rate and complications. Monitoring was performed with a 7-day event loop recorder at 3, 6 and 12 months and annually from the 2nd year. Success was defined by recurrence of AF (duration >30 seconds). Kaplan Meier survival curves were used to estimate the risk of events and the groups were compared using Chi-square and Mann-Whitney analysis. Results A total of 232 pts (60±12 years, 68% males) underwent CB. 29 pts had CPT (28 – common left pulmonary trunk and 2 – common right pulmonary trunk). Baseline characteristics were similar between groups, except for CHA2DS2VASc score and prior cerebrovascular disease history which were higher in CPT pts (3±2 vs 2±2, p=0.001; 24.1% vs 6.8%, p=0.007, respectively). The mean baseline CHA2DS2VASc was 2±2 and the median post-CB follow-up was 135 (IQ 32–249) days. Both the 1 and 3 year arrhythmic recurrence after AF ablation was not significantly different when comparing CPT and non CPT group with a 3 year success rate of 95.8% in pts with CPV against 86.5% in pts without CPT (p=0.299). There was no difference between groups (p=0.296; p=0,164, respectively) regarding the time of the procedure, radiation dose and rate of complications. Conclusions In our experience, balloon cryoablation for PVI is a safe and successful procedure in patients with CPT anatomical variation. FUNDunding Acknowledgement Type of funding sources: None.

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The role of left atrial wall thickness and pulmonary vein anatomy in success of pulmonary vein isolation using the CLOSE protocol

European Heart Journal ◽

10.1093/eurheartj/ehab724.0264 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

M Boussoussou ◽

B Vattay ◽

B Szilveszter ◽

M Kolossvary ◽

M Vecsey-Nagy ◽

...

Keyword(s):

Pulmonary Vein ◽

Wall Thickness ◽

Left Atrial ◽

Pulmonary Veins ◽

Logistic Regression Models ◽

Funding Sources ◽

Coronary Ct ◽

First Pass ◽

Procedural Success ◽

The Right

Abstract Introduction The CLOSE protocol is a novel contact-force guided technique for enclosing pulmonary veins in patients with atrial fibrillation (AF). Consistency and lesion contiguity are essential factors for procedural success. We sought to determine whether left atrial (LA) wall thickness (LAWT) and pulmonary vein (PV) dimensions as assessed by coronary CT angiography (CTA) could influence the efficacy of successful first-pass isolation using the CLOSE protocol. Methods In a single center, prospective study we enrolled 94 patients with symptomatic, drug-refractory AF who underwent pre-ablation left atrial CTA and initial radiofrequency catheter ablation between 2019.01–2020.09. The LA was divided into 11 regions when assessing LAWT. Additionally, the diameter and area of the PV orifices were obtained. First pass isolation was recorded separately for the right and left PVs. After the first pass ablation circles were ready, additional ablations were applied in those cases where first pass isolation was not achieved, to reach complete PV isolation. Predictors of successful first pass isolation were determined using logistic regression models that included anthropometrical, echocardiographic and CTA derived parameters. Results A total of 94 patients were included in the analysis with mean CHA2DS2-VASc score of 2.1±1.5 (mean age 62.4±12.6 years, 39.5% female). 61.7% were paroxysmal, 38.3 were persistent AF patients. Mean procedure times were 81.2±19.3 minutes. Complete isolation of all four PVs was achieved in 100% of patients. First-pass isolation rate was 76%, 71% and 54%, for the right PVs, left PVs and all four PVs, respectively. No difference was found regarding comorbidities and imaging parameters between those with and without first pass isolation. LAWT (mean of all 11 regions or separately) had no effect on the procedural outcome (all p>0.05). Out of all assessed parameters, only RSPV diameter was associated with right sided successful PVI on first pass isolation (p=0.04, OR 1.01). Conclusion The use of CLOSE protocol in AF patients resulted in high periprocedural success rate in terms of first pass isolation, independently from the thickness of the LA wall. RSPV diameter could influence the results of first pass isolation. FUNDunding Acknowledgement Type of funding sources: None.

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Does use of an antiarrhythmic drug prior to cryoballoon pulmonary vein isolation impact the duration of the post-ablation blanking period?

European Heart Journal ◽

10.1093/eurheartj/ehab724.0529 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

M Saberito ◽

N Milstein ◽

A Bhatt ◽

M Habibi ◽

T Sichrovsky ◽

...

Keyword(s):

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Antiarrhythmic Drug ◽

Loop Recorder ◽

Funding Sources ◽

Long Term Follow Up ◽

The Impact ◽

First 90 Days ◽

Af Recurrence

Abstract Background At time of cryoballoon (CB) pulmonary vein isolation (PVI), some patients with atrial fibrillation (AF) are on an antiarrhythmic drug (AAD) while others are not. The impact of AAD use at time of CB PVI on the duration of post-ablation blanking period (BP) is unknown. Objective To determine whether the optimal BP duration differs between pts who were and were not taking an AAD at time of CB PVI. Methods We enrolled consecutive pts with AF who had initial CB PVI; all pts had an implantable loop recorder (ILR). We prospectively followed all pts and determined the time to last AF episode during the 90-day post-PVI BP. This was then correlated with likelihood of having an AF recurrence between 3–12 months post-PVI. Results The cohort included 165 pts (66±9 years; 99 [60%] male; 91 [55%] PAF; CHA2DS2-VASc 2.7±1.6). An AAD was being used at some point prior to ablation in 120 (73%) pts. An AAD was being used at time of CB PVI in 92 (77%) of these 120 pts; this was stopped at a median of 80 [36, 105] days post-PVI. We defined 4 distinct groups: (1) no AF in 90-day BP (n=75 [45%]); (2) last AF within 30 days of PVI (n=32 [19%]); (3) last AF within 60 days of PVI (n=17 [10%]); and (4) last AF within 90 days of PVI (n=41 [25%]). Patients not exposed to an AAD prior to CB PVI had significantly lower likelihood of having no AF in the first 90-days post ablation (p=0.004, Figure). In contrast, if AF was observed post-ablation, as time from ablation to recurrence increased, so did likelihood of long-term failure from ablation (Figure); this relationship was not impacted by use of an AAD. Conclusion The best long-term outcomes post CB PVI are seen in pts who had no prior exposure to an AAD and had no AF within the first 90 days of ablation. Subsequently, as the time from ablation to AF recurrence increased within the 90-day BP, so did likelihood of recurrent AF during long-term follow-up, irrespective of whether an AAD was or was not used. FUNDunding Acknowledgement Type of funding sources: None.

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Defining the blanking period duration after cryoballoon pulmonary vein isolation in patients taking an antiarrhythmic drug

EP Europace ◽

10.1093/europace/euab116.251 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

D Musat ◽

NS Milstein ◽

M Saberito ◽

A Bhatt ◽

M Habibi ◽

...

Keyword(s):

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Antiarrhythmic Drug ◽

High Likelihood ◽

Loop Recorder ◽

Funding Sources ◽

Very High ◽

Af Recurrence

Abstract Funding Acknowledgements Type of funding sources: None. Background Cryoballoon pulmonary vein isolation (CB) is an accepted method for ablation in patients with atrial fibrillation (AF). A three-month blanking period (BP) is commonly used in clinical trials and practice. However, the actual BP duration in patients (pts) on an antiarrhythmic drug (AAD) at time of ablation remains undefined. Objective To objectively define the BP duration in pts undergoing CB while taking an AAD. Methods We enrolled consecutive pts with AF who had CB PVI while on an AAD. All pts had an implantable loop recorder (ILR). We prospectively followed all pts and determined the time to last AF episode during the 90-day post-PVI BP. This was then correlated with likelihood of having an AF recurrence between 3-12 months post-PVI. Results The cohort included 92 pts (66 ± 10 years; 62 [67%] male; 33 [36%] PAF; CHA2DS2-VASc 2.6 ± 1.7). AADs used included dofetilide (42), dronedarone (14), amiodarone (25), sotalol and propafenone (3 each), and flecainide (5). The AAD was stopped at a median of 80 [36, 105] days post-PVI. We defined 4 distinct groups: (1) no AF in 90-day BP (n = 45 [49%]); (2) last AF within 30 days of PVI (n = 17 [18%]); (3) last AF within 60 days of PVI (n = 13 [15%]); and (4) last AF within 90 days of PVI (n = 17 [18%]). Following the 90-day BP, 47 (51%) pts had a recurrence of AF. Once recurrent AF was observed > 30 days post-ablation, patients had high likelihood of having a long term AF recurrence (p = 0.037, Figure). Conclusion Our data suggest that the optimal BP duration in AF patients undergoing CB PVI while taking an AAD is 30 days. An AF recurrence after 30 days is associated with a very high likelihood of recurrent AF during longer-term follow-up. Abstract Figure.

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A study on pulmonary venous ostia pattern in the left atrium and its clinical applications

National Journal of Clinical Anatomy ◽

10.1055/s-0040-1701737 ◽

2018 ◽

Vol 7 (04) ◽

pp. 201-204

Author(s):

Rajesh S. ◽

Vijaya Kumar S. ◽

Manikanda Reddy V.

Keyword(s):

Atrial Fibrillation ◽

Radio Frequency ◽

Left Atrium ◽

Pulmonary Vein ◽

Anatomical Variation ◽

Pulmonary Veins ◽

Clinical Applications ◽

Ectopic Beats ◽

The Right ◽

Formalin Fixed

Abstract Background & aims : Normally four pulmonary veins open into the left atrium. Frequently there are variations in the number of pulmonary veins opening in to the left atrium. Ectopic beats in atrial fibrillation commonly originates from the ostia of the pulmonary veins. The treatment of atrial fibrillation is by radio frequency ablation of the focus of origin and hence the knowledge of anatomical variation of pulmonary veins is necessary to find the ectopic focus in the origin of atrial fibrillation. Materials and Method : In this study the variation of pulmonary venous ostia pattern in the left atrium was studied in 80 formalin fixed adult cadaveric hearts. Results and Conclusion : 63 hearts showed no variation in the pulmonary venous ostia pattem which accounts for 78.75%, rest of the 17 hearts showed variation in the pulmonary venous ostia which accounts for 21.25%, the variation in the number of pulmonary veins was slightly higher for the left side [11.25%] when compared to the right sided variation [ 10%], the number of hearts which showed bilateral variation was noted in 2 hearts - both showed a single pulmonary vein opening on either side which accounts for 2.5%

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Is the optimal blanking period duration after cryoballoon pulmonary vein isolation impacted by use of antiarrhythmic drugs?

EP Europace ◽

10.1093/europace/euab116.254 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

D Musat ◽

NS Milstein ◽

M Saberito ◽

A Bhatt ◽

M Habibi ◽

...

Keyword(s):

Pulmonary Vein ◽

Pulmonary Vein Isolation ◽

Loop Recorder ◽

Funding Sources ◽

Very High ◽

Period Duration ◽

Af Recurrence ◽

Funding Acknowledgements

Abstract Funding Acknowledgements Type of funding sources: None. Background Cryoballoon pulmonary vein isolation (CB) is an accepted method for ablation in patients with atrial fibrillation (AF). A three-month blanking period (BP) is commonly used in clinical trials and practice. However, when the optimal BP duration differs in patients (pts) on or off an antiarrhythmic drug (AAD) at time of ablation remains undefined. Objective To compare the BP duration in pts undergoing CB while either taking or not taking an AAD. Methods We enrolled consecutive pts with AF who had CB PVI while on an AAD. All pts had an implantable loop recorder (ILR). We prospectively followed all pts and determined the time to last AF episode during the 90-day post-PVI BP. This was then correlated with likelihood of having an AF recurrence between 3-12 months post-PVI. Results The cohort included 164 pts (66 ± 9 years; 97 [60%] male; 90 [55%] PAF; CHA2DS2-VASc 2.7 ± 1.7). Ablation was performed with 92 (56%) pts taking an AAD, which was stopped at a median of 80 [36, 105] days post-PVI. We defined 4 distinct groups: (1) no AF in 90-day BP (n = 75 [46%]); (2) last AF within 30 days of PVI (n = 32 [20%]); (3) last AF within 60 days of PVI (n = 17 [10%]); and (4) last AF within 90 days of PVI (n = 40 [24%]). Following the 90-day BP, 81 (49%) pts had a recurrence of AF. Long-term freedom from recurrent AF was similar in pts who did and did not use an AAD, irrespective of BP duration (Figure). Conclusion Our data suggest that the optimal BP duration in AF patients undergoing CB PVI while taking an AAD is 30 days. An AF recurrence after 30 days is associated with a very high likelihood of recurrent AF during longer-term follow-up, irrespective of whether an AAD is being used or not. Abstract Figure.

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P1402Isolation of pulmonary veins with duty-cycled circular multi-polar catheter: randomized controlled clinical trial

EP Europace ◽

10.1093/europace/euaa162.088 ◽

2020 ◽

Vol 22 (Supplement_1) ◽

Author(s):

J De Sousa ◽

N Cortez-Dias ◽

L Carpinteiro ◽

G Silva ◽

A Nunes Ferreira ◽

...

Keyword(s):

Clinical Trial ◽

Success Rate ◽

Pulmonary Veins ◽

Central Element ◽

Similar Efficacy ◽

Conventional Technique ◽

Added Value ◽

Controlled Clinical Trial ◽

Radiofrequency Energy ◽

Loop Recorder

Abstract Introduction Pulmonary vein isolation (PVI) is the central element in the ablation of atrial fibrillation (AF), and can be obtained with different ablation modalities. The duty-cycled circular multi-pole catheter PVAC® (Medtronic) allows linear application of radiofrequency energy, with the production of circumferential lesions. Conceptually, it can make ablation simpler and faster in patients with favorable anatomy. Objectives To evaluate the safety and efficacy of ablation with a PVAC® catheter and to compare it with the conventional technique point-by-point (PbP) with irrigated catheter. Methods Clinical trial with single-blinded patients with AF refractory to antiarrhythmic therapy, randomized (1: 1) for ablation with PVAC® or PbP. The ablation strategy consisted of PVI, complemented with ablation of the cavo-tricuspid isthmus in patients with history of concomitant flutter. Monitoring was performed with a 7-day event loop recorder at 3, 6 and 12 months and annually from the 2nd year. Success was defined by AF-free survival or any maintained supraventricular tachycardia (duration > 30seconds). Results 354 patients (67.5% males, 58 ± 12 years, PbP: 175, PVAC: 179) were included, of which 59.1% had paroxysmal, 26.2% short-standing persistent and 14.7% had long-standing persistent AF. Baseline characteristics were similar between groups. Among patients treated with PVAC, 93.1% of the pulmonary veins were isolated (620/666), similar to the 98.3% immediate success of the PbP group (697/709). Although the complication rate was similar in both groups (PVAC: 4.9% vs. PbP: 7.8%; P = NS), the risk of hemopericardium was lower with PVAC (0% vs. 4.6%; P = 0.013). Two patients treated with PVAC developed stroke (1.13% vs. 0%; P = NS). The duration of the procedure was lower among the patients treated with PVAC [136 (100-180) vs. 230 (188-270) min; P <0.001], with no difference in fluoroscopy time [24.4 (14.5-36.8) vs. 27.1 (17.0-45.0) min]. The success rate after 1st ablation at 36 months was 68%, with no differences between groups. The success rate after multiple ablations increased to 85.8%, with no differences between groups. Conclusion The multipolar PVAC catheter can represent an added value in AF ablation, making the procedure simpler and faster, ensuring similar efficacy to the conventional technique and with a lower risk of cardiac tamponade. The present trial suggests the need for clinically manifested stroke risk surveillance, which may be increased with this technique. Abstract Figure.

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Earliest pulmonary vein potential guided cryoballoon ablation is associated with better clinical outcomes than conventional cryoballoon ablation: a result from two randomized clinical studies

European Heart Journal ◽

10.1093/eurheartj/ehab724.0361 ◽

2021 ◽

Vol 42 (Supplement_1) ◽

Author(s):

J Yonekawa ◽

Y Mizutani ◽

D Yamashita ◽

Y Makino ◽

T Hiramatsu ◽

...

Keyword(s):

Clinical Outcomes ◽

Pulmonary Vein ◽

Cryoballoon Ablation ◽

Short Term ◽

Term Outcome ◽

Long Term Outcome ◽

Funding Sources ◽

Baseline Characteristics ◽

First Time

Abstract Background With regards to short-term outcome in atrial fibrillation (AF), the benefit of cryoballoon ablation (CBA) by pressing a balloon against the earliest pulmonary vein (PV) potential site during pulmonary vein isolation, (earliest potential [EP]-guided CBA) has been previously demonstrated. Objective The present study aimed to evaluate the long-term outcome of the EP-guided CBA. Methods This study included 136 patients from two randomized studies, who underwent CBA for paroxysmal AF for the first time. Patients were randomly assigned to the EP-guided and conventional CBA groups in each study. In the EP-guided CBA group, we pressed a balloon against the EP site when the time to isolation (TTI) after cryoapplication exceeded 60 s and 45 s in the first and second studies, respectively. The patients were followed up for 1 year after procedure. We compared the clinical outcomes between the EP-guided CBA group (68 patients) and the conventional CBA group (68 patients). Results No significant differences in baseline characteristics were observed between the two groups. Compared with the conventional CBA group, the EP-guided CBA group had a significantly higher success rate at TTI ≤90 s (98.5% vs. 90.0%, P<0.001); lower touch-up rate and total cryoapplication; and shorter procedure time, and fluoroscopy time. The recurrence at 1-year after ablation was significantly lower in the EP-guided CBA group than in the conventional CBA group (6.0% vs. 19.4%; P=0.019). Conclusions The EP-guided CBA approach can facilitate the ablation procedure and achieve low recurrence at 1-year after ablation. FUNDunding Acknowledgement Type of funding sources: None. Earliest potential [EP]-guided CBA The recurrence at 1-year after ablation

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Catheter ablation of long-standing persistent atrial fibrillation: the ugly type of AF?

EP Europace ◽

10.1093/europace/euab116.087 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

S Couto Pereira ◽

T Rodrigues ◽

J Brito ◽

P Silverio Antonio ◽

B Valente Silva ◽

...

Keyword(s):

Atrial Fibrillation ◽

Catheter Ablation ◽

Success Rate ◽

Cox Regression ◽

Therapeutic Option ◽

Pulmonary Veins ◽

Ablation Techniques ◽

Loop Recorder ◽

Af Ablation ◽

History Of

Abstract Funding Acknowledgements Type of funding sources: None. Introduction In atrial fibrillation (AF) patients (pts), catheter ablation (CA) by isolating pulmonary veins (PVI) is the most effective therapeutic option in order to maintain sinus rhythm. The success rate of CA relies on type and duration of AF, being more successful in pts with paroxysmal AF and presenting suboptimal success in pts with long-standing persistent AF (LSPAF, >12 months). Purpose To evaluate the success of AF ablation, particularly in LSPAF. Methods Single-center prospective study of pts submitted to CA between 2004 and 2020. The strategy, regardless of the type of AF, was based on PVI, complemented by cavo-tricuspid isthmus line (CTI) in pts with history of flutter. Additional CA strategies were selectively considered in pts with stable atypical flutter conversion, persistent triggers or no electrograms in the VPs. Pts were monitored with Holter/7-day event loop recorder (3, 6, 12 months and annually up to 5 years). Success was assessed from the 90th day after ablation, with the absence of recurrences of any sustained atrial arrhythmias (> 30 sec). Cox regression and Kaplan-Meier survival were used to compare the success of ablation as a function of the clinical type of AF. Results 862 pts were submitted to AF ablation (67.3% male, mean age of 58 ± 0.41 years), including 130 pts (15.1%) with LSPAF, 63.3% with paroxysmal AF and 21.6% with short-duration persistent AF (SDPAF). In LSPAF, PVI was performed with irrigated catheter in 26.4%, PVAC in 39.5% and cryoablation in 34.1%. With a mean follow up period of 838 (IQ 159-1469) days, the 3-year success rate after a single procedure was 54.1% in LSPAF, compared to 72.4% in paroxysmal AF and 61.6% in SDPAF (LogRank - p < 0.0001 - figure 1). The risk of arrhythmic recurrence was 37% higher in patients with LSPAF comparing with other groups (HR 0.63 CI 95% 0.43-0.92, p 0.016). However after a mean of 1.17 procedures/patients, the success difference between groups was not detect (LogRank – p = 0.112 – figure 2). With additional ablation procedures (REDO), the success rate at 3 years was 82.9% LSPAF pts, compared 88.2% in paroxysmal AF pts and 83.6% in SDPAF pts. In LSPAF pts, different ablation techniques did not predict arrhythmic recurrence. Regarding comorbidities, higher prevalence of peripheral arterial disease (PAD, p = 0.005) a higher NT-proBNP (p = 0.006) and left auricular volume (p = 0.045) were associated with arrhythmic relapse. Conclusions AF ablation is more effective when performed earlier in the natural history of the disease. However, even in LSPAF pts, with additional procedures an acceptable rate of success can be achieve, independently from the ablation techniques. Abstract Figures 1 and 2: Success of AF ablation

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Benefits of catheter ablation of typical cavotricuspid isthmus-dependent atrial flutter using half-normal saline

EP Europace ◽

10.1093/europace/euab116.081 ◽

2021 ◽

Vol 23 (Supplement_3) ◽

Author(s):

N Vecchio ◽

C Militello ◽

JC Lopez Diez ◽

N Schnetzer ◽

J Dorado ◽

...

Keyword(s):

Catheter Ablation ◽

Success Rate ◽

Atrial Flutter ◽

Normal Saline ◽

Anatomical Variation ◽

Safe Procedure ◽

Test Analysis ◽

Cavotricuspid Isthmus ◽

Funding Sources ◽

Significant Difference

Abstract Funding Acknowledgements Type of funding sources: None. Background Radiofrequency catheter ablation (RFA) of cavotricuspid isthmus–dependent atrial flutter (AFL) is a procedure with a high success rate and a low complication rate. The anatomical variation and irregularity of the isthmus, with the high local blood flow, can reduce the effectiveness of the lesion and consequently of the procedure. Recent data suggests that deeper ablation lesions can be created using open-irrigated catheters (CA) with half-normal saline (HNS). Purpose To assess the acute efficacy and safety of RFA of AFL with half-normal saline (HNS). Compare the results with CA irrigated with normal saline (NS). Methods Randomized, prospective, observational and single-center study. Consecutive patients with first AFL RFA between June 2019 and December 2020 were included. CA with HNS or NS were used, with a limit of 40 watts and 40° C. An RFA line was performed under fluoroscopic guidance or electroanatomic mapping. If necessary, the lesion was repeated until the arrhythmia was interrupted and the bidirectional block was achieved (success). Acute success, total radiofrequency time (RT), number of radiofrequency applications, and complications were analyzed. Results 38 patients with RFA of AFL were analyzed. 19 in the HNS and 19 in the NS group. There were no significant differences between the baseline characteristics of each group. (Table 1) The accute success rate was 100% with a median of 2 RFA applications in both groups. The mean RT in HNS was 7:10 vs 09:16 min in NS group; the t-test analysis did not show a significant difference (p = .2). A subanalysis was performed in those patients who required more than 2 lines of RFA; a mean of 4 in the HNS group vs 6 in the NS group (p = .4). In the HNS group, RT was significantly shorter; 8:17 vs 13:17 min in the NS group (p = .011). (Figure 1) There was a steam pop in the HNS group and no complications or steam pop in the NS group (p = .53). Conclusions RFA of AFL using HNS is an effective and safe procedure. In patients with unfavorable anatomy who required a greater number of applications, the radiofrequency time was significantly shorter using HNS. Baseline characteristicsHNS (19 p)NS(19 p)pAge56 ± 12.3 years61 ± 10.8 years.22Male16 p (84%)16 p (84%)1Heart Disease7 p (36.8%)5 p (26.3%).68Ejection Fraction57.1 ± 11%56 ± 14.3%.49Ejection Fraction < 50%2 p (10.5%)2 p (10.5%)1Electroanatomic mapping10 p (52.6%)8 p (42.1%).7Abstract Figure. Fugure 1

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Totally Thoracoscopic Pulmonary Vein Isolation

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000428 ◽

2017 ◽

Vol 12 (6) ◽

pp. 493-495

Author(s):

Meelad I.H. Al-Jazairi ◽

Theo J. Klinkenberg ◽

Bart P. Van Putte ◽

Massimo A. Mariani ◽

Stefano Benussi

Keyword(s):

Atrial Fibrillation ◽

Surgical Technique ◽

Minimally Invasive ◽

Success Rate ◽

Pulmonary Vein ◽

Pulmonary Veins ◽

Operating Time ◽

Drug Free ◽

Established Treatment ◽

Mini Thoracotomy

Since the introduction of thoracoscopic ablation for atrial fibrillation (AF), the field of minimally invasive AF treatment has evolved toward an established treatment option for AF, with an overall 2-year antiarrhythmic drug free success rate of 77%. Complications are usually minor, and the incidence of bleeding needing conversion to sternotomy or (mini-)thoracotomy varies between 0% and 1.6%. Bleeding is often related to encircling the pulmonary veins, which is a blind maneuver that has to be done without direct camera vision. We propose here a modified surgical technique to simplify the procedure, shorten the operating time, and lower the risk of complications.

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