P1431Radiofrequency ablation of left atrium in patients with mitral valve replacement. The future of surgical treatment for atrial fibrillation in mitral valve disease?

EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A Utyasheva ◽  
I V Abdulyanov ◽  
M A Sungatullin ◽  
I I Vagizov
Keyword(s):  
Atrial Fibrillation ◽  
Surgical Treatment ◽  
Mitral Valve ◽  
Sinus Rhythm ◽  
Left Atrium ◽  
Pulmonary Veins ◽  
Pacemaker Implantation ◽  
Valve Prosthesis ◽  
Diagnostic Center ◽  
Valve Pathology

Abstract Aims   The evaluation of sinus rhythm preservation after surgical treatment of atrial fibrillation by left-atrial RFA in patients with mitral valve prosthetics. Materials and methods  A prospective, randomized study was performed in the interregional clinical and diagnostic center of Kazan in 2011-2018 which were included 136 patients with mitral valve pathology and persistent AF. The average age of patients was 57 ± 5, the gender division was dominated by female patients  and made up 97 (58.4%). All patients underwent either mitral valve prosthesis with mechanical prosthesis Meding-2 which made up 96 (70.5%) or biological prosthesis Carpantier-Edwards which made up 40 (29.4%). Radiofrequency isolation of the left atrium and pulmonary veins was performed by standard procedure by Cox-IV which doesn’t include the right atrium tissue. Results and discussion: In the early post surgical period, recovery of sinus rhythm was observed in 111 (81.6%) patients. Cardiac Pacemaker Implantation was performed in 1 (0.73%) case.  The results of the study were assessed after surgical treatment in 22 ± 5 months, the sinus rhythm was preserved in 99 patients from the study group and made up 72.7%. Conclusion Radiofrequency ablation  the left atrium provides long-term preservation of sinus rhythm in the treatment of patients with atrial fibrillation and mitral valve pathology.

scholarly journals Surgical Treatment of Atrial Fibrillation with Electhocautery during Mitral Valve Replacement

2016 ◽  
Vol 9 (1) ◽  
pp. 9-12
Author(s):  
Rampada Sarker ◽  
Manoz Kumar Sarker ◽  
Md Ataher Ali ◽  
Abdul Khaleleque Beg
Keyword(s):  
Atrial Fibrillation ◽  
Surgical Treatment ◽  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Heart Block ◽  
Complete Heart Block ◽  
Pulmonary Veins ◽  
Maze Procedure ◽  
Number Of Patients

Background: The Maze procedure is the surgical treatment that can alleviate the three complications of atrial fibrillation- tachycardia, thrombo-embolism and hemodynamic compromise. We attempted ablation of atrial fibrillation with monopolar eletrocautery.Our objective was to evaluate the results of surgical treatment of atrial fibrillation by ablation of the left atrial wallaround the pulmonary veins with conventional electrocautery during mitral valve replacement.Methods:This retrospective observational study was carried out in the Department of Cardiac Surgery, National Institute of cardiovascular diseases, Dhaka, Bangladesh,from January 2014 to February 2016. Ablation of AF with monopolar electrocautery was done during mitral valve replacement. Recurrence of atrial fibrillation, any new arrhythmia, complete heart block, bleeding and perforation was noted during the operation and in postoperative period. Patients were followed up upto three months after the surgery.Results: All the Patients were free from atrial fibrillation after the procedure. At discharge 100 %, after I month 96.2% and after 3 months 92.3 % patient were free from atrial fibrillation. No patients developed complete heart block requiring pace maker and there was no incidence of atrial perforation at the sites of ablation.Conclusion: The surgical treatment of the atrial fibrillation with elcetrocautery during mitral valve replacement is able to reverse this arrhythmia in a significant number of patients during short term follow-up without any complication.Cardiovasc. j. 2016; 9(1): 9-12

scholarly journals Оperation «labyrinth» in surgical treatment of combined mitral-аоrtic failures

2020 ◽  
Vol 87 (7-8) ◽  
pp. 25-28
Author(s):  
V. V. Popov ◽  
А. А. Bolshak ◽  
V. V. Lazoryshynets
Keyword(s):  
Surgical Treatment ◽  
Sinus Rhythm ◽  
Left Atrium ◽  
Low Frequency ◽  
Posterior Wall ◽  
Late Results ◽  
Late Period ◽  
Results Of Treatment ◽  
Valve Pathology ◽  
The Waves

Objective. Studying possibilities concerning the proposed procedure of intraoperative restoration of the sinus rhythm in surgical treatment of combined mitral-аоrtic failures. Маterials and methods. Results of treatment of 42 patients, suffering combined mitral-aortic failures and constant forms of the atria fibrillation, who were operated in Аmosov National Institute of Cardiovascular Surgery in period from 01.01.2006 tо 01.01.2013 yr. Median presence of the atria fibrillation have constituted (3.7 ± 0.4) yrs. Besides correction of the valve pathology, in the patients a simultant operation «labyrinth» was performed. Fragmentation in left atrium was performed, using a low-frequency (25 - 35 W in regime of diathermocoagulation) аblation of the left atrium wall in the operation variant «left labyrinth-III». Оbligatory condition of fragmentation have served the external ligation and resection of the left atrium auricle. Plasty of left atrium with re-entry was performed in 29 (69.0%) patients with the objective of its diameter reduction and exclusion of the waves expansion. Аtrioplasty was performed, using method of paraannular plication of the left atrium posterior wall (16 patients) and of triangular plasty (13 patients). In late period, in (9.1 ± 2.1) yr at average, the treatment results in 37 (94.9%) patients were studied. Results. Of 42 оperated patients 3 died (hospital mortality have constituted 7.1%) during the hospital stage. The sinus rhythm have had restored after the operation immediately in 34 (80.9%) patients, аnd in discharge from the hospital (11 - 13th postoperative day) persisted in 31 (73.8%) patient. Rate of restoration and preservation of the sinus rhythm in group of patients, in whom plasty of left atrium was performed, was higher, than in group of patients without plasty of left atrium: 86.2 and 46.2%, accordingly (р < 0.05). In late period good and satisfactory results of the operation were noted in 83.8% patients. During first 5 postoperative years the sinus rhythm have been preserved in 67.8% patients. Conclusion. After correction of combined mitral-aortic failures with the simultant fragmentation operation on left atrium («labyrinth») in our modification in concomitant fibrillation of the heart atria a successful restoration of the sinus rhythm was noted in 73.8% patients on the hospital stage and its preservation during 5 postoperative years in 67.8% of the patients. Reduction of left atrium in its dilatation enhances possibility of the sinus rhythm restoration. Immediate and late results of operations permits to estimate the proposed procedure gains positively.

Long-term results of simultaneous hybrid ablation of therapy-resistant atrial fibrillation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Baimbetov ◽  
K Bizhanov ◽  
I Yakupova ◽  
B Bairamov ◽  
U Medeubekov ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Left Atrium ◽  
Atrial Flutter ◽  
Pulmonary Veins ◽  
Long Term Results ◽  
Hybrid Ablation

Abstract Background A hybrid technique using thoracoscopic epicardial and standard endocardial ablation of atrial fibrillation (AF) is a strategy used to treat AF patients with therapy-resistant symptomatic AF. We conducted comparative study of efficacy and safety of simultaneous hybrid ablation in patients with non-paroxysmal forms of AF and evaluated the factors that determine success and quality of life. Methods The study included 56 consecutive patients who underwent simultaneous hybrid ablation. First, epicardial ablation was performed using thoracoscopic access: to isolate the pulmonary veins and the posterior wall of the left atrium. After this, an endocardial electrophysiological assessment was carried out from the pulmonary veins to the left atrium and additional endocardial ablation was performed, where necessary. The next day, a loop ECG recorder was implanted subcutaneously in the thoracic region. Efficiency was evaluated using implanted loop ECG recorders. The average follow up was 24 months, the studied patients came to the clinic every 3 months to receive diagnostic reports from loop recorders. Recurrence was defined as AF, atrial flutter and other atrial tachycardia, recorded in reports of loop recorders lasting &gt;30 sec during follow up period. Results Continuous follow up was carried out in 56 patients, the average age of which was 57±9 years. Of these, 39 (70%) men, 6 (10%) paroxysmal, 38 (68%) persistent and 12 (22%) long-standing persistent AF. Within 24 months of follow up, 45 (80%) maintened a sinus rhythm. Most recurrenses were atrial flutter (8/11 patients). Success was associated with factors such as left atrial size, patient age and duration of arrhythmia. Patients with paroxysmal AF had the highest success, patients with long-standing persistent AF had the least success. 5 (9%) patients had complications associated with the procedure. Quality of life after ablation improved in patients with sinus rhythm. Conclusion The efficiency of simultaneuous hybrid AF ablation was 80% for 24 months of continuous follow up period associated with the type of AF. Quality of life improved significantly, complications associated with the procedure occurred in 9%. Funding Acknowledgement Type of funding source: None

scholarly journals Electrical anatomy of the left atrium during atrial fibrillation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
P Adragao ◽  
D Nascimento Matos ◽  
F Costa ◽  
P Galvao Santos ◽  
G Rodrigues ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Left Atrium ◽  
Pulmonary Vein ◽  
Refractory Period ◽  
Cycle Length ◽  
Low Voltage ◽  
Pulmonary Veins ◽  
Short Cycle ◽  
Superior Pulmonary Vein

Abstract Introduction Twenty years ago, pulmonary veins (PV) ostia were identified as the left atrium (LA) areas with the shortest refractory period during sinus rhythm. Pulmonary veins isolation (PVI) became standard of care, but clinical results are still suboptimal. Today, a special tool using the Carto® electroanatomical mapping (EAM) allows for AF cycle length mapping (CLM), to identify the areas in the left atria with shortest refractory period, during atrial fibrillation. Using this EAM tool, our study aimed to find the LA areas with the shortest refractory period to better recognize electrical targets for catheter ablation. Methods Retrospective analysis of an unicentric registry of individuals with symptomatic drug-refractory AF who underwent PVI with Carto® EAM. CLM was performed with a high-density mapping Pentaray® catheter before and after PVI and in 4 redo procedures. We assessed areas of short cycle length (SCL) (defined as 120 to 250ms), and their relationships with complex fractionated atrial electrograms (CFAE), and low-voltage zones (from 0.1 to 0.3mV). Results A total of 18 patients (8 men, median age 63 IQR 58–71 years) were included. Most patients presented with persistent AF (n=12, 67%), and 4 patients (22%) had a previous PVI. The mean shortest measured cycle length in AF was 140ms (SD ±27ms). All patients presented areas of SCL located in the PVs or their insertion, 70% in the posterior/roof region adjacent to the left superior pulmonary vein (LSPV) (figure 1) and 60% in the anterior region of the right superior pulmonary vein (RSPV). These two areas remained the fastest even after PVI. The anterior mitral region rarely presented SCL (17%). SCL were related to low-voltage areas in 94% and were adjacent to CFAE. Low-voltage areas and CFAE were more frequent and had a larger LA dispersion than SCL. Conclusion We confirmed in 3D mapping that PVs are the LA zones with shortest refractory period, not only in sinus rhythm but also during AF. The persistence of SCL areas in the border zones of the PVI lines suggest the benefit of a more extensive CLM guided ablation. Larger studies are needed. FUNDunding Acknowledgement Type of funding sources: None. Short cycle length mapping

Radiofrequency pulmonary veins isolation of atrial fibrillation in patients undergoing mitral valve replacement

Open Medicine ◽  
2006 ◽  
Vol 1 (1) ◽  
pp. 58-68
Author(s):  
Maciej Grabowski ◽  
Tomasz Hryniewiecki ◽  
Tomasz Gawałkiewicz ◽  
Janina Stępińska ◽  
Andrzej Biederman
Keyword(s):  
Atrial Fibrillation ◽  
Mitral Valve ◽  
Mitral Valve Disease ◽  
Pulmonary Veins ◽  
Pacemaker Implantation ◽  
Coronary Bypass ◽  
Functional Class ◽  
Valve Disease ◽  
Tricuspid Valve Repair ◽  
Valve Implantation

AbstractIntroduction: Pulmonary veins isolation (PVI) is useful method in patients (pts) with mitral valve disease (MVD) and chronic atrial fibrillation (AF) during prosthetic valve implantation.The aim of the study: To evaluate e.ectiveness of PVI in the treatment of AF in pt with MVD during valve implantation.Material and methods: 45 pts (mean age 55 yrs) with AF were operated on for MVD.RF ablation around the pulmonary veins, a lesion between them and to the mitral annulus were performed. There were 44 prostheses implanted, 1 case of mitral valve annuloplasty, associated with tricuspid valve repair (5 pts), aorto-coronary bypass procedure (2 pts), ASD II closure (1 pt).Results: SR was achieved in 2 (44,5%) pts, 21 (46,5%)pts were in AF, 4 (9%) pts needed pacing. No correlation between SR restoration and preoperative echocardiographic parameters, age, gender, NYHA functional class were found. In long-term follow-up 1 pt have reversed AF to SR spontaneously. There were 6 cases of paroxysmal AF,1 pt needed pacemaker implantation. 20 (44,5%) pts are in SR, 20 (44,5%) in AF, 5 (11%) in permanent pacing.Conclusion: PVI with RF use is effective in restoring sinus rhythm in patients with chronic AF secondary to mitral valve disease.

scholarly journals Short- and mid-term results of thoracoscopic atrial fibrillation ablation

2020 ◽  
Vol 8 (4S) ◽  
pp. 82-88
Author(s):  
E. A. Khomenko ◽  
S. E. Mamchur ◽  
K. A. Kozyrin ◽  
R. S. Tarasov ◽  
K. V. Bakovsky
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Catheter Ablation ◽  
Sinus Rhythm ◽  
Left Atrium ◽  
Atrial Flutter ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Pulmonary Veins ◽  
One Year

Aim. Evaluation of short- and mid-term (up to one year) results of aт atrial fibrillation thoracoscopic radiofrequency ablation (TRFA) combined with left atrial appendage resection.Methods. 10 patients with persistent AF were included in the study. In 5 cases surgical ablation was performed as the primary intervention and in 5 cases surgery were preceded by two unsuccessful catheter procedures. Age of the patients was 54.4 (41; 63) years, duration of arrhythmic anamnesis – 5.6 (4.8; 6.8) years, anteroposterior size of the left atrium – 4.7 (45; 51 mm), LV ejection fraction – 63 (58; 68) %. TRFA included an isolation of right and left pulmonary veins, ablation lines along the roof and base of posterior wall of the left atrium, left atrial appendage resection.Results. In all cases of TRFA exit-block from the pulmonary veins was achieved. Among 10 procedures, a stable sinus rhythm was documented in 6 patients. In the remaining 4 patients AF was observed only in one case, and the other three demonstrated atypical atrial flutter, that given us a reason to repeat catheter procedures. In three cases of left atrial flutter, catheter ablation led to sinus rhythm restoration, and in case of AF and total sclerosis of left atrium a decision to refuse RF ablation was made. Complications were presented by a single case of bilateral phrenic nerve palsy, which required plication of the diaphragm, and two spontaneously resolved pulmonary atelectasis.Conclusion. The efficacy of atrial fibrillation thoracoscopic radiofrequency ablation during the follow-up period of one year was 90% regarding selective hybrid approach (thoracoscopic + catheter procedure). Procedure safety of TRFA was much lower than that of catheter ablation: the total number of small and big complications was 30%.

scholarly journals Electrical anatomy of the left atrium during atrial fibrillation

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
P Adragao ◽  
D Nascimento Matos ◽  
F Costa ◽  
P Galvao Santos ◽  
G Rodrigues ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Left Atrium ◽  
Pulmonary Vein ◽  
Refractory Period ◽  
Cycle Length ◽  
Low Voltage ◽  
Pulmonary Veins ◽  
Density Mapping ◽  
Superior Pulmonary Vein

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Twenty years ago, pulmonary veins (PV) ostia were identified as the left atrium (LA) areas with the shortest refractory period during sinus rhythm. Pulmonary veins isolation (PVI) became standard of care, but clinical results are still suboptimal. Today, a special tool using the Carto® electroanatomical mapping (EAM) allows for AF cycle length mapping (CLM), to identify the areas in the left atria with shortest refractory period, during atrial fibrillation. Using this EAM tool, our study aimed to find the LA areas with the shortest refractory period to better recognize electrical targets for catheter ablation. Methods Retrospective analysis of an unicentric registry of individuals with symptomatic drug-refractory AF who underwent PVI with Carto® EAM. CLM was performed with a high-density mapping Pentaray® catheter before and after PVI and in 4 redo procedures. We assessed areas of short cycle length (SCL) (defined as 120 to 250ms), and their relationships with complex fractionated atrial electrograms (CFAE), and low-voltage zones (from 0.1 to 0.3mV). Results A total of 18 patients (8 men, median age 63 IQR 58-71 years) were included. Most patients presented with persistent AF (n = 12, 67%), and 4 patients (22%) had a previous PVI. The mean shortest measured cycle length in AF was 140ms (SD ±27ms). All patients presented areas of SCL located in the PVs or their insertion, 70% in the posterior/roof region adjacent to the left superior pulmonary vein (LSPV) (figure 1) and 60% in the anterior region of the right superior pulmonary vein (RSPV). These two areas remained the fastest even after PVI. The anterior mitral region rarely presented SCL (17%). SCL were related to low-voltage areas in 94% and were adjacent to CFAE. Low-voltage areas and CFAE were more frequent and had a larger LA dispersion than SCL. Conclusion   We confirmed in 3D mapping that PVs are the LA zones with shortest refractory period, not only in sinus rhythm but also during AF. The persistence of SCL areas in the border zones of the PVI lines suggest the benefit of a more extensive CLM guided ablation. Larger studies are needed. Abstract Figure 1

Sign in / Sign up

Export Citation Format

Share Document