303 * SYSTEMATIC REVIEW COMPARING ENDOCARDIAL FULL MAZE TO EPICARDIAL ABLATION AND HYBRID PROCEDURE ON SAFETY AND EFFICACY OF MINIMALLY INVASIVE SURGICAL ABLATION FOR LONE ATRIAL FIBRILLATION

Advances in surgery for atrial fibrillation from cut and sew technique to thoracoscopy and new energy source have enabled minimally invasive approach which avoids median sternotomy and cardiopulmonary bypass. However, minimally invasive approach is unable to match the outcome of classic surgical technique due to difficulty in creating some of linear ablation lines. Hybrid procedure using catheter mapping and ablation in addition to minimally invasive surgical ablation has gained interest to combine the advantages of both procedures. No large study has been conducted to date comparing this new technique to other existing treatments. The aim of this paper is to review the data on hybrid procedure for atrial fibrillation and assess its early outcome and efficacy.

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Commentary: How can we improve minimally invasive surgical ablation of atrial fibrillation?

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2021.03.062 ◽

2021 ◽

Author(s):

Leonid Sternik

Keyword(s):

Atrial Fibrillation ◽

Minimally Invasive ◽

Surgical Ablation ◽

Minimally Invasive Surgical

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Minimally invasive surgical ablation of atrial fibrillation: The thoracoscopic box lesion approach

Journal of Interventional Cardiac Electrophysiology ◽

10.1007/s10840-007-9172-3 ◽

2007 ◽

Vol 20 (3) ◽

pp. 83-87 ◽

Cited By ~ 54

Author(s):

J. Crayton Pruitt ◽

Robert R. Lazzara ◽

George Ebra

Keyword(s):

Atrial Fibrillation ◽

Minimally Invasive ◽

Surgical Ablation ◽

Minimally Invasive Surgical

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Minimally Invasive Epicardial Surgical Ablation Alone Versus Hybrid Ablation for Atrial Fibrillation: A Systematic Review and Meta-Analysis

Arrhythmia & Electrophysiology Review ◽

10.15420/aer/2017.29.2 ◽

2017 ◽

Vol 6 (4) ◽

pp. 202 ◽

Cited By ~ 8

Author(s):

Charles M Pearman ◽

Shi S Poon ◽

Laura J Bonnett ◽

Shouvik Haldar ◽

Tom Wong ◽

...

Keyword(s):

Systematic Review ◽

Minimally Invasive ◽

Meta Analysis ◽

Radiofrequency Energy ◽

Complication Rates ◽

Atrial Arrhythmias ◽

Epicardial Ablation ◽

Surgical Ablation ◽

Meta Regression ◽

Hybrid Ablation

Maintaining sinus rhythm in patients with non-paroxysmal AF is an elusive goal. Some suggest that hybrid ablation, combining minimally invasive epicardial surgical ablation with endocardial catheter ablation, may be more effective than either modality alone. However, randomised trials are lacking. We investigated whether hybrid ablation is more effective than epicardial ablation alone at preventing recurrent AF by performing a systematic review and meta-analysis. The review was prospectively registered with PROSPERO (CRD42016043389). MEDLINE and EMBASE were searched for studies of standalone minimally invasive epicardial ablation of AF and/or hybrid ablation, identifying 41 non-overlapping studies comprising 2737 patients. A random-effects meta-analysis, meta-regression and sensitivity analysis were performed. Single-procedure survival free from atrial arrhythmias without antiarrhythmic drugs was similar between epicardial-alone and hybrid approaches at 12 months (epicardial alone 71.5 %; [95 % CI 66.1–76.9], hybrid 63.2 %; [95 % CI 51.5–75.0]) and 24 months (epicardial alone 68.5 %; [95 % CI 57.7–79.3], hybrid 57.0 %; [95 % CI 33.6–80.4]). Freedom from atrial arrhythmias with AADs and rates of unplanned additional catheter ablations were also similar between groups. Major complications occurred more often with hybrid ablation (epicardial alone 2.9 %; [95 % CI 1.9–3.9], hybrid 7.3 %; [95 % CI 4.2–10.5]). Meta-regression suggested that bipolar radiofrequency energy and thoracoscopic access were associated with greater efficacy, but adjusting for these factors did not unmask any difference between epicardial-alone and hybrid ablation. Hybrid and epicardial ablation alone appear to be equally effective treatments for AF, although hybrid ablation may be associated with higher complication rates. These data derived from observational studies should be verified with randomised data.

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Surgical Treatment of Isolated (Lone) Atrial Fibrillation with Gemini-S Ablation and Left Atrial Appendage Excision (GALAXY Procedure)

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0b013e3182560612 ◽

2012 ◽

Vol 7 (1) ◽

pp. 33-38 ◽

Cited By ~ 8

Author(s):

John R. Doty ◽

Stephen E. Clayson

Keyword(s):

Atrial Fibrillation ◽

Minimally Invasive ◽

Left Atrial ◽

Left Atrial Appendage ◽

Persistent Atrial Fibrillation ◽

Atrial Appendage ◽

Lone Atrial Fibrillation ◽

Surgical Ablation ◽

Invasive Approach ◽

The Galaxy

Objective Surgical ablation with radiofrequency is a safe and effective treatment for atrial fibrillation. Recent advances in instrumentation have allowed for the application of bipolar radiofrequency through a minimally invasive approach using small bilateral thoracotomies for pulmonary vein isolation, destruction of autonomic ganglia, and excision of the left atrial appendage (GALAXY procedure). Methods Thirty-two patients underwent surgical ablation of atrial fibrillation with the GALAXY procedure over a 43-month period. Data were collected in a prospective manner during hospitalization and at 1-, 3-, 6-, and 12-month intervals for rhythm, medications, and subsequent interventions. Results There were no operative mortality, no myocardial infarction, and no stroke. One patient required reexploration for bleeding. Mean follow-up was 28 months (range, 4–43 months). Freedom from atrial fibrillation at 12 and 24 months, respectively, was 90% and 67% for patients with paroxysmal fibrillation and 80% and 63% for patients with persistent atrial fibrillation. Of the patients who were not in sinus rhythm, four reverted to atrial fibrillation and two reverted to atrial flutter. Conclusions The GALAXY procedure is a safe and effective, minimally invasive method for treatment of isolated (lone) atrial fibrillation. The operation provides excellent short-term freedom from atrial fibrillation and should be considered in patients with isolated paroxysmal atrial fibrillation.

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Minimally Invasive Surgical Therapies for Atrial Fibrillation

ISRN Cardiology ◽

10.5402/2012/606324 ◽

2012 ◽

Vol 2012 ◽

pp. 1-12 ◽

Cited By ~ 5

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.

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