scholarly journals Thoracoscopic infrared ablation to create a box lesion as a treatment for atrial fibrillation

2022 ◽  
Vol 17 (1) ◽  
Author(s):  
Hiroshi Kubota ◽  
Toshiya Ohtsuka ◽  
Mikio Ninomiya ◽  
Takahiro Nonaka ◽  
Motoyuki Hisagi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Left Atrial Appendage ◽  
Thoracoscopic Surgery ◽  
Posterior Wall ◽  
Beating Heart ◽  
Bottom Line ◽  
Case Presentation ◽  
Permanent Atrial Fibrillation ◽  
Direct Current Cardioversion

Abstract Background Creating a box lesion in the posterior wall of the left atrium from the epicardial side of the beating heart remains a challenge. Although a transmural lesion can be created by applying radiofrequency (RF) energy at clampable sites, it is still difficult to create a transmural lesion at unclampable sites because the inner blood flow in the unclampable free wall weakens the thermal effect on the outside. Our aim was to apply the newly developed infrared coagulator to create linear transmural lesions on the beating heart thoracoscopically to treat atrial fibrillation (AF). Case presentation A 71-year-old male was referred to our hospital with a diagnosis of hypertrophic cardiomyopathy and permanent atrial fibrillation. The patient was first diagnosed with atrial fibrillation 20 years before. Direct current cardioversion had been performed every few years a total of four times, but sinus rhythm restoration had always been temporary. On February 27, 2020, thoracoscopic PV isolation together with infrared roof- and bottom-line ablation to create a box lesion and left atrial appendage amputation (LAAA) were performed. The coagulator could be applied to clinical thoracoscopic surgery to successfully create a box lesion without any complication. The patient restored a regular sinus rhythm, it has been maintained for eleven months, and there have been no adverse events. Conclusions The infrared coagulator might have enough potential to create transmural lesions on the beating heart in thoracoscopic AF surgery.

scholarly journals Thoracoscopic infrared ablation to create a box lesion as a treatment for atrial fibrillation

2021 ◽  
Author(s):  
Hiroshi Kubota ◽  
Toshiya Ohtsuka ◽  
Mikio Ninomiya ◽  
Takahiro Nonaka ◽  
Motoyuki Hisagi ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Thoracoscopic Surgery ◽  
Posterior Wall ◽  
Beating Heart ◽  
Bottom Line ◽  
Permanent Atrial Fibrillation ◽  
Direct Current Cardioversion ◽  
F Wave ◽  
Rf Energy

Abstract BackgroundCreating a box lesion in the posterior wall of the left atrium from the epicardial side of the beating heart remains a challenge. Although a transmural lesion can be created by applying radiofrequency (RF) energy at clampable sites, there is still no reliable energy source to use to create a roof and bottom linear lesion to connect bilateral pulmonary vein (PV) cuff lesions produced with RF energy, because the inner blood flow in the unclampable free wall weakens the thermal effect on the outside. Our aim was to apply the newly developed infrared coagulator to create linear transmural lesions on the beating heart thoracoscopically to treat atrial fibrillation (AF).Case presentationA 71-year-old male was referred to our hospital with a diagnosis of hypertrophic cardiomyopathy and permanent atrial fibrillation. The patient was first diagnosed with atrial fibrillation 20 years before. Direct current cardioversion had been performed every few years a total of four times, but sinus rhythm restoration had always been temporary. The patient wanted to be free from anticoagulant therapy, symptom of palpitations, and fear of possibility of cerebral infarction. Transthoracic echography revealed no valvular dysfunction. Cardiac scintigraphy showed no evidence of myocardial ischemia. The electrocardiogram indicated AF with a 0.2 mV of f-wave amplitude. On February 27, 2020, thoracoscopic PV isolation together with infrared roof- and bottom-line ablation to create a box lesion and left atrial appendage amputation (LAAA) were performed. The coagulator could be applied to clinical thoracoscopic surgery to successfully create a box lesion without any complication. The patient restored a regular sinus rhythm, it has been maintained for eleven months, and there have been no adverse events. ConclusionsThe infrared coagulator might have enough potential to create transmural lesions on the beating heart in thoracoscopic AF surgery.

Abstract 14352: Staged Hybrid Atrial Fibrillation Ablation With Addition of Endoscopic Left Atrial Appendage Closure Reduces Arrhythmia Recurrence Between 3 and 12 Months Compared to Non-staged Hybrid Without Closure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
David C Kress ◽  
Lynn Erickson ◽  
Ana C Perez Moreno ◽  
Imran Niazi ◽  
M. Eyman Mortada ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Hybrid Approach ◽  
Persistent Atrial Fibrillation ◽  
Posterior Wall ◽  
Atrial Appendage ◽  
Closure Device ◽  
Epicardial Ablation

Introduction: The hybrid, or convergent procedure, uses a minimally invasive combined epicardial/endocardial ablation approach for patients in persistent AF. In the staged hybrid approach, the electrophysiologist performs the endocardial ablation a minimum of 30 days after the surgeon performs epicardial ablation. Placement of a left atrial appendage (LAA) closure device (AtriCure AtriClip) has been shown to electrically isolate the LAA. Added to the scar formation on the posterior wall via epicardial ablation, it eliminates additional substrate in persistent atrial fibrillation (AF). Hypothesis: Patients with persistent AF who underwent a staged hybrid approach with thoracoscopic placement of the AtriClip may have less likelihood of arrhythmia recurrence between 3 and 12 months compared with those who underwent nonstaged hybrid ablations without use of the AtriClip. Methods: Patients in persistent or long-standing paroxysmal AF underwent ablation using either a staged hybrid approach with AtriClip (n=23) or a nonstaged hybrid approach without AtriClip (n=136). Groups were compared by running a t-test (mean±SD) or Wilcoxon rank sum [median, interquartile range (IQR)]. Categorical data were compared with Pearson’s chi-squared test. Results: Significantly fewer patients who had undergone a staged hybrid with AtriClip recurred with arrhythmia (2, 8.7%) compared to those with a nonstaged, no AtriClip approach (40, 29.4%) (p=0.04) between 3 and 12 months. The staged hybrid approach also had significantly fewer patients requiring cardioversion to restore sinus rhythm during the procedure (p<0.001). Conclusions: A staged hybrid approach with AtriClip placement reduced recurrent arrhythmia between 3 and 12 months compared to a nonstaged hybrid procedure without AtriClip. A benefit was also seen in a steep reduction in the need for cardioversion during the subsequent endocardial ablation to restore sinus rhythm.

Left-thoracoscopic Convergent ablation for atrial fibrillation

2020 ◽  
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Pulmonary Veins ◽  
Persistent Atrial Fibrillation ◽  
Posterior Wall ◽  
Beating Heart ◽  
Thoracoscopic Approach ◽  
Occlusion Device ◽  
Left Atrial Posterior

Epicardial Convergent ablation followed by endocardial touch-up and an additional ablation may be superior to catheter-based interventions in patients with persistent atrial fibrillation. We sought to extend the epicardial lesion set by changing the standard subxiphoid thoracotomy to a left-lateral, totally thoracoscopic approach. This tutorial depicts a closed-chest, beating-heart procedure, including ablation of the left atrial posterior wall, the left atrial dome, and the left pulmonary veins. The left atrial appendage is closed using an epicardial occlusion device.

P3731The improvement in left atrial strain among patients undergoing percutaneous left atrial appendage closure

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Ijuin ◽  
A Hamadanchi ◽  
F Haertel ◽  
L Baez ◽  
C Schulze ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Transesophageal Echocardiography ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Lateral Wall ◽  
Bleeding Risk ◽  
Atrial Appendage ◽  
Left Atrial Appendage Closure ◽  
Left Atrial Strain

Abstract Background Percutaneous left atrial appendage closure (LAAC) is being established as an alternative option for atrial fibrillation (AF) patients with high bleeding risk. Few studies reported the influence of percutaneous LAAC on left atrial (LA) performance, but most of the studies demonstrated no remarkable changes in their parameters after the procedure. Method The study included 95 patients (age: 75±6.7 years, 67% male) whom underwent percutaneous LAAC in a single center between September 2012 and November 2018. LA strain was evaluated at three different time intervals by transesophageal echocardiography (baseline, 45 days and 180 days after procedure). All data were analyzed using a dedicated. 70 patients had atrial fibrillation whereas 25 were in sinus rhythm. Analysis was performed for peak atrial longitudinal strain (PALS) and peak atrial contraction strain (PACS) from segment of lateral wall in mid-esophageal 4 chamber view. The validity of lateral wall left atrial analysis was recently shown by our group. PACS was obtained in patients with sinus rhythm during exams. Results Compared to baseline, PALS was significantly increased after 45 days (12.4±8.4% vs 16.0±10.7%, p=0.001) and remained stable after 180 days (13.8±9.0% vs 17.0±12.4%, p=0.098). Even in only patients with atrial fibrillation during exams, it was increased (10.8±7.7% vs 13.4±7.1%, p=0.012 and 8.5±5.1% vs 13.9±8.1%, p=0.014). Similarly, compared with the baseline, PACS was significantly increased after 45 days and 180 days (5.8±3.9% vs 10.6±7.6%, p=0.001 and 4.5±2.6% vs 7.9±3.1%, p=0.036). The Changes in PALS and PACS Conclusion Our study has demonstrated for the first time the improvement in LA strain following LAAC within 45 days of implantation by transesophageal echocardiography and these values were maintained at least for 6 months. Further appraisal is warranted for confirmation of these preliminary findings.

Abstract 14676: Landmark-based Functional Computed Tomography Reveals Diminished Left Atrial Appendage Contraction During Atrial Fibrillation

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Jonathan H Chung ◽  
Gordon Ho ◽  
Andrew Schluchter ◽  
Francisco Contijoch ◽  
Jonathan C Hsu ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Atrial Fibrillation ◽  
Ejection Fraction ◽  
Sinus Rhythm ◽  
Ct Scan ◽  
Blood Volume ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Atrial Appendage ◽  
History Of

Introduction: The formation of thrombus in the left atrial appendage (LAA) and risk for systemic embolization may result in part from stasis and poor blood volume emptying during atrial fibrillation (AF). Functional 4-dimensional computed tomography (4DCT) is a promising technique to measure LAA ejection fraction and blood volume emptying. Hypothesis: We hypothesize that the LAA ejection fraction measured by 4DCT is decreased during AF compared to sinus rhythm. Methods: 256-slice 4DCT scans obtained in patients for coronary artery imaging or pre-procedurally for AF, VT or SVT ablation procedures were analyzed retrospectively. In each patient, LAA volumes were measured at multiple phases during one cardiac cycle using segmentation software (ITK-SNAP and Osirix MD). LAA ejection fraction was calculated as the difference between minimum and maximum volumes and was analyzed using Wilcoxon rank sum. Results: Out of 54 patients, 37 patients were in sinus rhythm and 17 patients were in AF. Between NSR vs. AF, mean age was 69.1±12.8 vs 73.2±11.5 years (p=0.13), 28% vs 36% female (p=0.54), LVEF was 58±11% vs 60±9% (p=0.95), and echo-derived left atrial volume index was 29.5±6.1 ml/m2 vs 41.7±12.8 ml/m2 (p=0.06). Patients who were in sinus rhythm during their CT scan had a higher LAA ejection fraction than those who were in AF (58±13% vs. 29±9%, p<0.0001). For patients who were in AF during their CT scan, there was no difference in LAA ejection fraction between patients with a history of paroxysmal AF compared to patients with a history of persistent AF (30±10% vs. 28±10%, p=0.75). Conclusions: Analysis of the LAA volumes using functional cardiac CT is a feasible method to quantify blood volume emptying from the LAA. Patients in AF were observed to have significantly decreased LAA ejection fraction and blood volume emptying compared to patients in sinus rhythm. Further studies are needed to determine whether this technique may improve personalized risk stratification for stroke.

Abstract 15692: Voltage Mapping in Atrial Fibrillation vs Sinus Rhythm: Results From the Mavs Study

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Carola Gianni ◽  
Jerri A Cunningham ◽  
Sanghamitra Mohanty ◽  
CHINTAN TRIVEDI ◽  
Domenico G Della Rocca ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Low Voltage ◽  
Lateral Wall ◽  
Posterior Wall ◽  
Anterior Wall ◽  
Inferior Wall ◽  
Voltage Mapping ◽  
First Time ◽  
Mapping Catheter

Background: Left atrial (LA) scar can be identified with bipolar voltage mapping during sinus rhythm (SR). It is not clear whether the same voltage criteria can be applied during atrial fibrillation (AF). Objective: Aim of this study was to compare voltage maps performed in the same patient both in AF and SR. Methods: Voltage mapping was performed using a 10-pole circular mapping catheter in patients with non-paroxysmal AF undergoing first time RF ablation. For descriptive purposes, the LA was divided in 6 regions: septum, posterior wall (PW), inferior wall (IW), lateral wall, anterior wall, and roof. The threshold for low voltage was <0.5 mV (with a color range setting 0.2-0.5 mV). Mild “scar” was defined as an area low voltage 5-20%, moderate 20-35% and severe as >35%. Results: 16 patients (62% persistent AF, 38% longstanding persistent AF) were included in the study. The map density was comparable during AF and SR (mean points per map 551 vs 547, paired t test P = NS). 2 patients displayed normal voltage during both AF and SR. 14 patients showed areas of low voltage during AF, which were still present during SR in 8. All patients with mild “scarring” during AF (n = 4), showed normal voltage during SR. Of the 7 patients with moderate “scarring”, 2 patients showed normal voltage during SR, while in the remaining 5 “scarring” was only mild during SR. 3 patients showed extensive “scarring” during AF, which was only moderate during SR. During AF, areas of low voltage were more commonly observed in the PW (12/14) followed by the IW (6/14) and antero-septum (4/14); while in SR, in the antero-septum (4/8), PW (3/8) and IW (3/8). Interestingly, in all patients both the PW/IW and (less dramatically) the antero-septum showed more “scarring” during AF as compared to SR. Conclusion: Areas of low voltage are more severe and diffuse during AF when compared to SR. When areas of low voltage are detected during AF, they are more commonly seen in the PW, IW and antero-septal areas.

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