scholarly journals Comparative characteristics of a pacemaker implantation after biatrial or left atrial ablation of atrial fibrillation in combination with coronary artery bypass grafting in patients with ischemic heart disease and long-standing persistent atrial fibrillation

Kardiologiia ◽  
2021 ◽  
Vol 61 (10) ◽  
pp. 46-52
Author(s):  
A. T. Kalybekova ◽  
S. S. Rakhmonov ◽  
V. L. Lukinov ◽  
A. M. Chernyavsky
Keyword(s):  
Atrial Fibrillation ◽  
Surgical Treatment ◽  
Postoperative Period ◽  
Left Atrial ◽  
Sinus Node ◽  
Persistent Atrial Fibrillation ◽  
Sinus Node Dysfunction ◽  
Av Block ◽  
Atrial Ablation

Aim      To compare the incidence of a permanent pacemaker (PP) implantation based on the chosen treatment technology (biatrial ablation, BA, or left atrial ablation (LAA) for long-standing persistent atrial fibrillation (AF) with simultaneous coronary bypass (CB).Material and methods  The study included 116 patients with long-standing persistent AF and indications for CB. Patients were randomized to two equal groups (58 patients in each). Group 1 underwent BA in combination with CB; group 2 patients underwent isolated LAA with simultaneous CB under the conditions of artificial circulation. Incidence of PP implantation was assessed during the early (to 30 days) and late (to 60 months) postoperative periods.Results For the observation period, a total of 9 PPs was implanted in both groups, 6 in the BA group and 3 in the LAA group (odds ratio, OR, 0.5; 95 % confidence interval, CI, 0.1–2.4; р=0.490). During the early postoperative period, 5 patients in the BA group and 2 patients in the LAA group were implanted with PP (OR, 0.4; 95 % CI. 0–2.5; р=0.438). During the late postoperative period, one (2%) patient of the BA group was implanted with a permanent PP at 30 months of follow-up due to the development of sick sinus syndrome (SSS); also, one (2%) patient of the LAA group required PP implantation at 54 months of follow-up due to the development of SSS. The causes for PP implantation in the BA group included the development of complete atrioventricular (AV) block in 9 % of cases (95 % CI, 4–19 %); sinus node dysfunction and junctional rhythm in 2 % of cases (95 % CI, 0–9 %). Compared to this group, the LAA group showed a statistically significant difference in the incidence of AV block (0 cases, р=0.047). The major cause for PP implantation in the LAA group was the development of sinus node dysfunction in 3 (5 %) patients (95 % CI, 2–14 %).Conclusion      The use of BA in surgical treatment of long-standing persistent AF with simultaneous myocardial revascularization is associated with a high risk of AV block, which requires permanent PP implantation in the postoperative period. Total incidence of permanent PP implantation for dysfunction of the cardiac conduction system following the combination surgical treatment of long-standing persistent AF and IHD, either CB and LAA or BA, did not differ between the treatment groups both in early and late postoperative periods. 

scholarly journals Comparative efficacy and safety of biatrial versus left atrial ablation in the surgical treatment of long-standing persistent atrial fibrillation with concomitant coronary artery bypass grafting in patients with ischemic heart disease

2021 ◽  
Vol 36 (2) ◽  
pp. 107-114
Author(s):  
A. T. Kalybekova ◽  
S. S. Rakhmonov ◽  
V. L. Lukinov ◽  
A. M. Chernyavskyi
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Surgical Treatment ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Left Atrial ◽  
Artery Bypass ◽  
Persistent Atrial Fibrillation ◽  
Bypass Grafting ◽  
Atrial Ablation

Purpose. To compare the results of biatrial (BA) and left atrial ablation (LAA) performed in patients with long-standing persistent atrial fibrillation (AF) with concomitant coronary artery disease (CAD) with indication for coronary artery bypass grafting (CABG).Material and Methods. A prospective, randomized, single-center, blinded study was conducted on the basis Meshalkin National Medical Research Center in the period from 2016 to 2019. A total of 116 patients with long-standing persistent AF and CAD were randomized into two groups: BA + CABG group (n = 58) and LAA + CABG group (n = 58). Patients of both groups underwent CABG surgery with the chosen atrial ablation technique (LAA or BA).Results: BA technique proved to be more effective in maintaining sinus rhythm (58%) compared with isolated LAA (31%) at 24 months (p = 0.019) after surgical treatment of long-standing persistent AF with concomitant CABG.Conclusion: BA technique was more effective than isolated LAA in the late postoperative period of 24 months.

scholarly journals A prospective randomized trial comparing biatrial and isolated left atrial ablation in patients with long-standing persistent atrial fibrillation undergoing CABG

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Kalybekova ◽  
A Chernyavskyi ◽  
V Lukinov
Keyword(s):  
Atrial Fibrillation ◽  
Right Atrium ◽  
Left Atrial ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Persistent Atrial Fibrillation ◽  
Coronary Syndrome ◽  
Atrial Ablation ◽  
The Right

Abstract Purpose To compare the efficacy and safety of left atrial ablation (LAA) with those of biatrial ablation (BA) in patients with long-standing persistent atrial fibrillation (AF) in common with CABG. Background AF is the most common heart rhythm disorder, while CAD is the most common cardiovascular disease. Chronic coronary syndrome and atrial fibrillation coexist in many patients. Long-standing persistent atrial fibrillation (AF) is frequent pathology in patients undergoing CABG. Surgical ablation in such patients is currently an effective treatment of AF. Pulmonary vein isolation (PVI) may reduce AF recurrences in 70% of patients with paroxysmal form of AF. However, the efficacy of ablation in patients with long-standing persistent AF is rather low. Clinical studies have shown that the right atrium can also be involved in the AF initiation and maintenance. Areas localized in both atrias are characterized by rapid electrical activity, which is critical in the AF persistence. Therefore, we have hypothesized that in long-standing persistent AF BA could be more effective than isolated LAA. Methods Between 2016 and 2019, 116 patients with long-standing persistent AF and CAD who underwent open-heart surgery were included in this single blind prospective randomized study and divided into two groups: 58 patients in group 1 underwent isolated LAA + CABG, and group II (58 patients) - BA + CABG. All the patients had Reveal LINQ ICM System (Medtronic, USA) implanted during the index procedure. The mean age was 65 [61; 67.75] years versus 62 [58; 66] years (p=0.050) and 83% versus 84% (p>0.999) were men in BA and LAA groups, respectively. The follow-up time was 22±3 months for two groups. The primary endpoint was freedom from AF during 24-month follow-up based on 24-hour Holter monitoring ECG registration and Reveal device data. Results This study has demonstrated that in CAD patients with long-standing persistent AF, PVI in combination with multiple linear lesions in the right atrium while GABG produce a significantly higher success rate than PVI alone. After 24 months, AF recurred in 38% of patients in the BA group and in 64% – in the LAA group (p=0.010). Univariate logistic regression analysis showed indicators as long axis of left atria in mm (OR 3.45, 95%; CI 1.77 to 7.64, p=0.001) in LAA group and (OR 2.02, 95%; CI 1.03 to 4.26, p=0.049) in-group BA increases the risk of AF. Chronic kidney disease (OR 2.95, 95% CI 1.05 to 9.22, p=0,048), and mitral regurgitation (OR 1.18, 95% CI 1.01 to 1.41, p=0.047) have been found the independent predictors of AF recurrence in the LAA group. Arrhythmia on the third day after procedure increases the risk of AF (OR 3.79, 95% CI 1.45 to 10. 58, p=0.008) in the LAA group in a long-term follow-up. Conclusion The study has demonstrated that BA is more effective for treatment of long-standing persistent AF in CAD patients undergoing CABG. Funding Acknowledgement Type of funding source: None

scholarly journals Sinus node dysfunction in patients with long-standing persistent atrial fibrillation: Clinical and laboratory parallels

2021 ◽  
Vol 36 (1) ◽  
pp. 123-128
Author(s):  
V. V. Evtushenko ◽  
A. V. Evtushenko ◽  
E. N. Pavlyukova ◽  
T. E. Suslova ◽  
A. M. Gusakova ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Node ◽  
Persistent Atrial Fibrillation ◽  
Sinus Node Dysfunction

scholarly journals An off-pump biatrial mini-maze procedure for treatment of long-standing persistent atrial fibrillation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
T Yan ◽  
S.J Zhu ◽  
M Zhu ◽  
C.F Guo
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Vena Cava ◽  
Persistent Atrial Fibrillation ◽  
Maze Procedure ◽  
Purse String ◽  
Off Pump ◽  
Bipolar Radiofrequency ◽  
The Right

Abstract Background Surgical treatment has assumed a more prominent role in the therapy of atrial fibrillation (AF) with favorable efficiency and acceptable safety during the last decades. The traditional Cox-Maze procedure and Wolf Mini-Maze procedure focused on left atrial ablation. However, it is ubiquitous that patients with long-standing persistent atrial fibrillation (LSPAF) typically suffer from biatrial electrical and structural remodeling. The left atrial procedures are still not enough in patients with LSPAF. Purpose Herein, we aimed to introduce a modified biatrial off-pump ablation procedure based on the Wolf Mini-Maze procedure and to detect the safety and efficacy of the surgery for patients with LSPAF. Methods Between January 2016 and September 2020, 102 patients of LSPAF underwent our modified Mini-Maze procedure using bipolar radiofrequency ablation. Those patients firstly underwent a Mini-Maze procedure using Dallas lesion set, including video-assisted bilateral mini-thoracotomy, left atrial appendage excision, bilateral pulmonary vein isolation, ganglionic plexi evaluation and destruction, left atrial roof connecting lesion, and a linear lesion connecting this roofline to the root of the aorta at the junction of the left coronary and the non-coronary cusp. Secondly, a purse-string suture was performed on the right atrium, and then four ablation lesions were made to the superior vena cava, to the inferior vena cava, to the appendix of the right atrium, and to the tricuspid valve annulus from the purse-string suture point by the bipolar radiofrequency clamp. After the operation, the patients were followed up at an interval of 3, 6, 12 months, and every 1 year after that. Results No mortality No surgical re-exploration for bleeding. No permanent pacemaker implantation. 99 patients were free from LSPAF upon discharge. A follow-up at interval of 3, 6, 12, 24, 36, and 48 months showed a success rate free from LSPAF was 95.1% (97/102), 94.4% (85/90), 94.8% (73/77), 91.5% (54/59), 90.3% (28/31) and 100% (9/9), respectively Conclusions The modified biatrial Mini-Maze suggested a safe and feasible procedure. Early follow-up demonstrated an acceptable success rate free from AF. It might have the potential to become another option for clinical treatment of LSPAF. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): General Program of the National Natural Science Foundation of China Schematic of the procedure

Sign in / Sign up

Export Citation Format

Share Document