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

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.

Short-term outcomes of surgical atrial ablation and septal myectomy

<p><strong>Background.</strong> Hypertrophic cardiomyopathy is one of the most common types of cardiomyopathy. The appearance of atrial fibrillation in patients with hypertrophic obstructive cardiomyopathy is associated with significant clinical worsening. Outcomes of surgical ablation and septal myectomy in these patients are limited.<br /><strong>Aim.</strong> This retrospective study aimed to evaluate short-term outcomes of concomitant surgical ablation and septal myectomy in patients with obstructive hypertrophic cardiomyopathy and atrial fibrillation.<br /><strong>Methods.</strong> Fifty-five patients with hypertrophic obstructive cardiomyopathy and atrial fibrillation who underwent concomitant surgical ablation and septal myectomy between 2014 and 2019 were analysed. Patients with paroxysmal atrial fibrillation predominantly underwent left atrial ablation, and those with nonparoxysmal atrial fibrillation predominantly underwent the Maze IV procedure. Surgical ablation was performed using cryoablation alone (83.6%) or in combination with radiofrequency energy (16.4%).<br /><strong>Results.</strong> Hospital mortality was 1.8%. Incidence of major adverse events was 3.6%. Sinus node dysfunction and atrioventricular block occurred in 7.3% and 1.8% of patients, respectively. Bleeding requiring revision occurred in 2 (3.6%) patients. Forty-nine (89.1%) patients had stable sinus rhythm and five (9.1%) were on dual-chamber pacemaker stimulation at the time of discharge.<br /><strong>Conclusion.</strong> Concomitant septal myectomy and surgical ablation are feasible and safe in patients with hypertrophic obstructive cardiomyopathy and atrial fibrillation.</p><p>Received 5 April 2021. Revised 16 May 2021. Accepted 17 May 2021.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> The authors declare no conflicts of interests.</p><p><strong>Contribution of the authors</strong><br />Conception and study design: A.S. Zalesov, A.V. Bogachev-Prokophiev<br />Data collection and analysis: A.S. Zalesov, S.A. Budagaev, A.V. Sapegin<br />Statistical analysis: A.S. Zalesov, A.V. Afanasyev, R.M. Sharifulin<br />Drafting the article: A.S. Zalesov<br />Critical revision of the article: A.V. Bogachev-Prokophiev, S.I. Zheleznev, I.I. Demin<br />Final approval of the version to be published: A.S. Zalesov, A.V. Bogachev-Prokophiev, A.V. Afanasyev, R.M. Sharifulin, A.V. Sapegin, S.A. Budagaev, S.I. Zheleznev, I.I. Demin</p>

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

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.

Irreversible Electroporation as an Alternative to Wound Debridement Surgery

Debridement is a standard part of wound care that is used on both acute and chronic wounds. Current methods of wound debridement include: autolytic based on the natural immune response, surgical, enzymatic based on application of exogenous proteases, mechanical using water jets and ultrasound, and biological using live organisms such as maggots. The choice of individual methods involves a trade-off between speed of treatment, selectivity, and pain. Irreversible electroporation via the application of pulsed electric fields has been used as a novel approach for deep tissue ablation, sometimes in conjunction with chemotherapy, as in the case of tumors, and also in cases where high precision is needed in otherwise very fragile tissues, such as for treating diabetic neuropathy and in epicardial atrial ablation. This method could be readily extended to wound care as it is both rapid and relatively painless, and it is also effective at decreasing bacterial load and clearing biofilms. Furthermore, the process primarily targets cells leaving the extracellular matrix relatively intact, thus providing a suitable natural scaffold for host cellular invasion and regrowth. A unique aspect of the use of pulsed electric fields is that around the region where ablation is perfomed, electric fields of lower energy are dissipated into the healthy tissue. There is a range of electric fields that are known to stimulate cellular functions, in particular migration and proliferation, and that may contribute to the healing process after electroporation. While irreversible electroporation is a potentially useful alternative to other debridement methods, future clinical application awaits technological advances in electrode design that will enable precise delivery of the therapy in wounds of various sizes and depths.