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.

Surgical Ablation Concomitant with Non-mitral valve surgery for Persistent Atrial Fibrillation

2021 ◽  
Author(s):  
Satoshi Kainuma ◽  
Masataka Mitsuno ◽  
Koichi Toda ◽  
Shigeru Miyagawa ◽  
Yasushi Yoshikawa ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Mitral Valve ◽  
Persistent Atrial Fibrillation ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Surgical Ablation

scholarly journals Persistent Atrial Fibrillation: The Role of Left Atrial Posterior Wall Isolation and Ablation Strategies

2021 ◽  
Vol 10 (14) ◽  
pp. 3129
Author(s):  
Riyaz A. Kaba ◽  
Aziz Momin ◽  
John Camm
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Pulmonary Veins ◽  
Treatment Strategies ◽  
Persistent Atrial Fibrillation ◽  
Posterior Wall ◽  
Cardiovascular Death ◽  
Good Effect ◽  
Complex Forms

Atrial fibrillation (AF) is a global disease with rapidly rising incidence and prevalence. It is associated with a higher risk of stroke, dementia, cognitive decline, sudden and cardiovascular death, heart failure and impairment in quality of life. The disease is a major burden on the healthcare system. Paroxysmal AF is typically managed with medications or endocardial catheter ablation to good effect. However, a large proportion of patients with AF have persistent or long-standing persistent AF, which are more complex forms of the condition and thus more difficult to treat. This is in part due to the progressive electro-anatomical changes that occur with AF persistence and the spread of arrhythmogenic triggers and substrates outside of the pulmonary veins. The posterior wall of the left atrium is a common site for these changes and has become a target of ablation strategies to treat these more resistant forms of AF. In this review, we discuss the role of the posterior left atrial wall in persistent and long-standing persistent AF, the limitations of current endocardial-focused treatment strategies, and future perspectives on hybrid epicardial–endocardial approaches to posterior wall isolation or ablation.

Minimally Invasive Fibrillating Heart Surgery: A Safe and Effective Approach for Mitral Valve and Surgical Ablation for Atrial Fibrillation

2013 ◽  
Vol 96 (2) ◽  
pp. 520-527 ◽  
Author(s):  
Paul S. Massimiano ◽  
Bobby Yanagawa ◽  
Linda Henry ◽  
Sari D. Holmes ◽  
Graciela Pritchard ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Mitral Valve ◽  
Minimally Invasive ◽  
Heart Surgery ◽  
Surgical Ablation

Simultaneous Catheter and Epicardial Ablations Enable a Comprehensive Atrial Fibrillation Procedure

2011 ◽  
Vol 6 (4) ◽  
pp. 243-247 ◽  
Author(s):  
Andy C. Kiser ◽  
Mark D. Landers ◽  
Ker Boyce ◽  
Matjaž šinkovec ◽  
Andrej Pernat ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Sinus Rhythm ◽  
Pulmonary Veins ◽  
Persistent Atrial Fibrillation ◽  
Chronic Atrial Fibrillation ◽  
Lesion Pattern ◽  
Atrial Size ◽  
Cardiac Surgeon ◽  
Successful Collaboration

Objective Transmural and contiguous ablations and a comprehensive lesion pattern are difficult to create from the surface of a beating heart but are critical to the successful treatment of persistent, isolated atrial fibrillation. A codisciplinary simultaneous epicardial (surgical) and endocardial (catheter) procedure (Convergent procedure) addresses these issues. Methods Patients with symptomatic atrial fibrillation who failed medical treatment were evaluated. Using only pericardioscopy, the surgeon performed near-complete epicardial isolation of the pulmonary veins and a “box” lesion on the posterior left atrium using unipolar radiofrequency ablation. Simultaneous endocardial catheter radiofrequency ablation completed pulmonary vein isolation, performed a mitral annular and cavotricuspid isthmus line of block, and debulked the coronary sinus. Twelve-month results for the Convergent procedure were compared with 12-month results for concomitant and pericardioscopic (stand-alone transdiaphragmatic/thoracoscopic) atrial fibrillation procedures using unipolar radiofrequency ablation. Results Sixty-five patients underwent the Convergent procedure (mean age, 62 y; mean body surface area, 2.17 m2; mean atrial fibrillation duration, 4.8 y; mean left atrial size, 5.2 cm). Ninety-two percent were in persistent or long-standing persistent atrial fibrillation. At 12 months, evaluation with 24-hour Holter monitors found 82% of patients in sinus rhythm, while only 47% of pericardioscopic and 77% of concomitant patients treated with unipolar radiofrequency ablation were in sinus rhythm. Conclusions Simultaneous epicardial and endocardial ablation improves outcomes for patients with persistent or longstanding persistent atrial fibrillation. This successful collaboration between cardiac surgeon and electrophysiologist is an important treatment option for patients with large left atriums and chronic atrial fibrillation.

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

scholarly journals Two Canine Cases of Mitral Valve Insufficiency with Atrial Fibrillation

1997 ◽  
Vol 50 (7) ◽  
pp. 399-402
Author(s):  
Yoko OGUCHI ◽  
Hideki MATSUMOTO ◽  
Yuko MASUDA ◽  
Sanae MASADA ◽  
Yoshihiro KUNO ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Mitral Valve ◽  
Mitral Valve Insufficiency ◽  
Valve Insufficiency

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.

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