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.

Prophylactic Effects of Metoprolol on the Prevention of Atrial Fibrillation after Cardiac Surgery Are Dose Dependent

2014 ◽  
Vol 17 (1) ◽  
pp. 54 ◽  
Author(s):  
Nan Cheng ◽  
Changqing Gao
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Heart Surgery ◽  
Beta Blockers ◽  
Open Heart Surgery ◽  
Asian Patients ◽  
Different Response ◽  
Prolonged Hospital ◽  
Dose Dependent ◽  
Study Dose

Atrial fibrillation (AF) is one of the most common complications after cardiac surgery. Many studies have reported an incidence of 20%-40% in patients undergoing open heart surgery, and the peak incidence usually occurs between the postoperative days [Fuller 1989; Aranki 1996; Svedjeholm 2000; Maisel 2001]. AF is commonly self-limited and rarely results in postoperative death. However, postoperative AF (POAF) is often associated with complications, including stroke, heart failure, prolonged hospital stay, and increased costs [Maisel 2001; Bramer 2010]. Many pharmacological methods have been used to prevent this complication, and beta-blockers, which have been investigated in several studies, have demonstrated effectiveness [Ali 1997; Connolly 2003; Crystal 2004; Halonen 2006; Imren 2007]. There is currently a consensus in the use of beta-blockers for the prevention of POAF. However, whether the effect of beta-blockers on POAF is dose dependent has not been widely studied [Coleman 2004; Lucio 2004]. In addition, patients with different racial backgrounds have a different response to metoprolol based on body shape. In addition, the CYP2D6 genotypes are different among white and Asian patients. In this study dose-dependent prophylactic effects of beta-blockers, which were obtained in a single center.

Clinical response to arginine vasopressin therapy after paediatric cardiac surgery

2012 ◽  
Vol 23 (3) ◽  
pp. 387-393 ◽  
Author(s):  
Christopher W. Mastropietro ◽  
Maria C. Davalos ◽  
Shivaprakash Seshadri ◽  
Henry L. Walters ◽  
Ralph E. Delius
Keyword(s):  
Blood Pressure ◽  
Cardiac Surgery ◽  
Arginine Vasopressin ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
P Value ◽  
Haemodynamic Instability ◽  
Post Operation ◽  
The Mean ◽  
Haemodynamic Improvement

AbstractObjectiveTo describe the haemodynamic response of children who receive arginine vasopressin for haemodynamic instability after cardiac surgery and to identify clinical variables associated with a favourable response.Materials and MethodsWe reviewed patients less than or equal to 6 years undergoing open heart surgery in our institution between January, 2009 and July, 2010 who received arginine vasopressin during the first 7 days post operation. Favourable responders were defined as those in whom blood pressure was increased or maintained and catecholamine score was decreased, or blood pressure was increased by greater than or equal to 10% of baseline and catecholamine score was unchanged at 6 hours following arginine vasopressin initiation.ResultsOf the 34 patients identified, 17 (50%) patients responded favourably to arginine vasopressin. At 6 hours, the mean blood pressure was increased by 32.2% in responders as compared with 4.6% in non-responders, with a p-value less than 0.001. The mean catecholamine score decreased by 30.1% in responders and increased by 7.6% in non-responders, with a p-value less than 0.001. Anthropometric, demographic, and intra-operative variables were similar in both groups, as was maximum dose of arginine vasopressin. The median time after arrival to the intensive care unit at which arginine vasopressin was initiated, however, was later in those who responded, 20 hours as compared with those who did not, 6 hours, with a p-value equal to 0.032.ConclusionsArginine vasopressin therapy led to haemodynamic improvement in only half of the children in this study, and improvement was more likely to occur if arginine vasopressin was initiated after the post-operative night.

MEASUREMENT IN MANAGEMENT OF ANXIETY IN CHILDREN FOR OPEN HEART SURGERY

PEDIATRICS ◽  
1972 ◽  
Vol 49 (2) ◽  
pp. 250-259
Author(s):  
Corinne M. Barnes ◽  
Frederic M. Kenny ◽  
Thomas Call ◽  
John B. Reinhart
Keyword(s):  
Heart Surgery ◽  
Open Heart Surgery ◽  
Mean Value ◽  
Child Psychiatrist ◽  
Nurse Specialist ◽  
Post Discharge ◽  
Coping Capacity ◽  
Endocrine Organs ◽  
Before And After ◽  
The Mean

A study of neuro-endocrine and behavioral response to psychological stress of 11 children having heart surgery was initiated. An attempt was made to learn if more overtly anxious children would respond differently during hospitalization and surgery than those who appeared to have better emotional control. All children in this study survived the surgery. It is suggested that prognosis is greatly related to the coping capacity of a child and his family to stress; that prognoses can be predicted if adequate assessments can be made; and that as more precise methods for evaluation of the neuro-endocrine response become available it will be useful to employ them to explore the complicated relationship between the central nervous system and the endocrine organs in relation to children under stress. Assessment of anxiety in affect and function was made by a child psychiatrist and a pediatric nurse specialist during the hospitalization and at outpatient follow-up. Twenty-four-hour urine collections were made after suture removal and pre- and post-discharge and analyzed for 17-hydroxycorticosteroids by a modification of the method of Porter and Silber. In terms of emotional stimulation of the adrenocortical axis, the days before surgery and of return from intensive care were the most stressful of the days studied. The mean value on the day before surgery was significantly greater than that on the day before discharge. Values for the day before and after suture removal were also elevated in comparison with the day before discharge. Hospitalization was seen as stressful in terms of the parameter studied with the mean of all inpatient values including the day of discharge being approximately double that obtained by pooling all outpatient determinations. Surprising to the researchers was the fact that no difference was found between values for overtly excessively anxious children versus their less anxious counterparts on specific days, or when pooled in-hospital values were contrasted. The degree of elevation of 17-OHCS was related to the situation. No correlation between our estimate of anxiety and 17-OHCS levels was found.

P1000Do patients with atrial fibrillation being at high-risk for stroke benefit from concomitant left atrial appendix closure during cardiac surgery

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Kozmik ◽  
J Pisarenko ◽  
N Mainhard ◽  
W Weissenberger ◽  
F Mourad ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Surgery ◽  
Propensity Score ◽  
Heart Surgery ◽  
Stroke Rate ◽  
Surgical Ablation ◽  
Propensity Score Stratification ◽  
Laa Closure ◽  
Overall Mortality

Abstract Background Left atrial appendix, as an essential source of systemic embolism and stroke in patients with atrial fibrillation, can be excluded during cardiac surgery, however the clinical benefit is as yet uncertain. Methods A total of 376 out of 3741 consecutive patients with atrial fibrillation presenting a high risk for stroke (CHA2DS2-VASc-Score ≥2 for men and ≥3 for women) who underwent heart surgery with cardiopulmonary bypass between 01/2012 and 12/2015 were analysed for mortality and stroke rate at 30 days, 12 and 24 months. Patients with concomitant LAA-closure alone (group1; n=107) were compared to patients with concomitant surgical ablation and LAA-closure (group2; n=85), and patients without surgical ablation and no LAA-closure (group3; n=184) as controls. To further adjust for pre- and intraoperative risk factors, a propensity score stratification analysis based on patients age, gender, EuroSCORE-2, CHA2DS2-VASc-Score and type of procedure was performed. Results Patients age was 72±8 years (mean±SD) and 33% were female. EuroSCORE-2 was 8.7±7.7%, 5.7±3.9%, and 5.4±8.4% and CHA2DS2-VASc-Score was 4.2±1.5, 3.9±1.4, and 4.1±1.4 on average for the respective groups. Mortality did not differ between groups at 30 days, 12 and 24 months. The incidence of stroke was 1.9% at 30 days, 4.8% at 12 and 6.7% at 24 months in group1. There was no stroke at 30 days and 12 months and 1.3% at 24 months in group2, and 1.8% at 30 days, 3.0% at 12 and 24 months in control group3. The overall mortality at 24 months was 27.1%, 20% and 24.6% respectively. After propensity score stratification, stroke rate showed significant benefit in group 2 (P=0.05) at 12 months and a hazard ratio of 0.17, 95% confidents limits 0.02–1.50, (P=0.08) at 24 months, whereas overall mortality did not significantly differ between the groups at 12 and 24 months follow-up. Conclusions In this propensity score stratification analysis, patients undergoing cardiac surgery with surgical ablation and concomitant LAA-closure had significant fewer strokes at 12 months follow-up compared to patients undergoing cardiac surgery with LAA-closure alone. Overall mortality did not significantly differ between the groups. Therefore, a concomitant LAA closure during heart surgery without additional surgical ablation does not show any clinical benefit in terms of reduced stroke rate or survival until 12 and 24 months follow-up.

Establishing Cardiac Surgery in Eastern Nepal: Early Results

2018 ◽  
Vol 16 (3) ◽  
pp. 257-263 ◽  
Author(s):  
Lokesh Shekher Jaiswal ◽  
Jagat Narayan Prasad ◽  
Prashant Shah ◽  
Narendra Pandit
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Heart Surgery ◽  
Heart Diseases ◽  
Nyha Class ◽  
Open Heart Surgery ◽  
Left Atrial Myxoma ◽  
Early Results ◽  
The Mean

Background: Only few dedicated cardiac centres provide cardiac surgery service in Nepal. We are the only government affiliated centre outside the capital providing this service. In this study, we aim to present our early results of cardiac surgery.Methods: This retrospective study was conducted at B P Koirala Institute of Health Sciences with objective of analysing the early results of cardiac surgery in the patients operated from July 2016 to March 2017.The data were analysed for patient demographics, type of surgery and cardiac disease, mortality, hospital and intensive care unit stay, valve related complications.Results: Total 51 major cardiac surgeries (42 on pump and nine off pump) were performed. There were 27 (53%) males and 24 (47%) females with median age of 36 years (range: 1 to 70 years). The cardiac diseases consisted of 28 rheumatic heart disease, 12 congenital heart diseases, five coronary artery disease, five chronic constrictive pericarditis and one left atrial myxoma. The mean cardiopulmonary bypass and cross clamp times were 106 ±35 and 80±26 minutes respectively. The mean intensive care unit and hospital stay was 4±2 and 8±3 days respectively. Two (4%) patients required re-exploration for mediastinal bleeding. There was no prosthetic valve thrombosis or infection.Two patients (4%) had superficial wound infections.There were four (7.8%) in hospital mortalities. Remaining 47 patients (91.8%) are in NYHA class I aftermean follow up duration of five months.Conclusions: Our early result of cardiac surgery is encouraging and has established the safety and feasibility of starting open heart surgery in other parts of Nepal.

scholarly journals Novel approach for atrial fibrillation ablation during open-heart surgery using cryoballoon technology

EP Europace ◽  
2012 ◽  
Vol 15 (1) ◽  
pp. 150-151
Author(s):  
Fabien Doguet ◽  
Aurélie Guiot ◽  
Martin Bernier ◽  
Arnaud Savouré ◽  
Frédéric Anselme
Keyword(s):  
Atrial Fibrillation ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Atrial Fibrillation Ablation ◽  
Open Heart ◽  
Novel Approach

Cardiopulmonary bypass strategy during concomitant surgical treatment of mitral valve disease and atrial fibrillation

Perfusion ◽  
2003 ◽  
Vol 18 (1) ◽  
pp. 19-24 ◽  
Author(s):  
Nicola Colangelo ◽  
Stefano Benussi ◽  
Simona Nascimbene ◽  
Simone Calvi ◽  
Alessandro Caldarola ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiopulmonary Bypass ◽  
Radio Frequency ◽  
Myocardial Protection ◽  
Heart Surgery ◽  
Pulmonary Veins ◽  
Open Heart Surgery ◽  
Radio Frequency Ablation ◽  
Low Flow ◽  
Time Required

In recent years, the popularity of simplified intraoperative ablation approaches to treat atrial fibrillation (AF) has been progressively increasing. Our group has described a left atrial procedure based on epicardial radio frequency ablation on cardiopulmonary bypass (CPB). We report our CPB and myocardial protection strategy in 157 patients who underwent AF ablation combined with open-heart surgery from February 1998 to February 2002. Since epicardial ablations are performed on CPB on the beating heart, the CPB strategy is crucial. Total normothermic CPB allows a safe dissection around the pulmonary veins on the decompressed heart; after the ablating catheter has been positioned, an adequate filling of the left atrium favours a uniform contact with the atrial wall. After crossclamping, low-flow retrograde cardioplegia delivery is administered while ablating endocardially to protect the main coronary arteries in the atrio-ventricular groove from radio frequency-related trauma. All patients were successfully weaned from CPB. Sinus rhythm was restored in 152 of 157 (96.8%) patients immediately after surgery. No procedure-related complications were recorded. Epicar-dial ablations allowed us to reduce significantly the aortic crossclamping time required for ablations. The conduct of CPB and myocardial protection play a central role in the surgical strategy by improving intraoperative feasibility and effectiveness of radio frequency ablation and preventing some of the potential postoperative complications related to the procedure.

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