Preliminary results of a limited thoracotomy: new approach to treat atrial fibrillation
Abstract
Objective: To determine efficacy of a new procedure combining epicardial bipolar radiofrequency (RF) pulmonary vein (PV) antrum isolation and ganglionated plexus (GP) ablation for treatment of atrial fibrillation (AF). Background: PV antrum electrical isolation and GP ablation have each been associated with elimination of AF. Both of these can be performed epicardially in a single combined surgical procedure, which may have advantages over endocardial ablation. Methods and Results: Twenty‐one subjects entered a prospective evaluation of limited thoracotomy epicardial bipolar PV antrum isolation, verified by PV recordings, with GP ablation, guided by GP mapping. Procedural success was defined as freedom from AF and antiarrhythmic agents during 1 year of follow‐up, including evaluation by prolonged continuous monitoring capable of detecting asymptomatic arrhythmias. All subjects had recordable PV potentials and GP activity prior to ablation. Circumferential epicardial bipolar RF eliminated PV potentials in 18 of 20 right and 14 of 20 left PV antra. This concurrently eliminated 79% of GP activity (125 of 159 active sites); nearly all remaining GP activity could then be eliminated using epicardial bipolar RF forceps. Fifteen of 20 (75%) subjects overall, and 14 of 16 (87.5%) subjects with paroxysmal or persistent AF had a successful procedure. Conclusion: Limited thoracotomy epicardial bipolar RF antrum isolation, verified by PV recordings, with GP ablation, guided by GP mapping, is effective treatment for AF and should be considered in patients with paroxysmal or persistent AF.
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Thoracoscopic pulmonary vein isolation with bipolar radiofrequency prevents recurrence of paroxysmal atrial fibrillation (69-91% freedom from arrhythmias at 1 year).
“Thoracoscopic PVI with bipolar radiofrequency prevents recurrence of paroxysmal AF (69-91% freedom from arrhythmias at 1 year, see Figure 18B for lesion set), 468,809,810”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [810]
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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., Castella, M., Diener, H.-C., Heidbuchel, H., Hendriks, J., et al. (2016) · European Heart Journal · doi:10.1093/eurheartj/ehw210 · Cited by 6,418 · see citing works
2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
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- Authors
- MCCLELLAND, J. H., DUKE, D., & REDDY, R.
- Corresponding author
- MCCLELLAND, JAMES H.
- Venue
- Journal of Cardiovascular Electrophysiology
- Publisher
- Wiley
- Published
- 2007-10-25
- Volume
- 18
- Issue
- 12
- Pages
- 1289-1295
- ISSN
- 1045-3873 (ISSN-L)
- 1540-8167
- OpenAlex
- W2050776096
- Semantic Scholar
- 75a477ebbc21d15ae43ba63d803f3e92c453ada6
- Cited by
- 90
- References
- 28
- Citations by year
- 2024: 1 · 2022: 2 · 2021: 1 · 2020: 1 · 2019: 2 · 2017: 5 · 2016: 10 · 2015: 7 · 2014: 6 · 2013: 6 · 2012: 10
- FWCI
- 7.28
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Cardiovascular Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- atrial fibrillation, limited thoracotomy, pulmonary vein antrum isolation, ganglionated plexus ablation, paroxysmal atrial fibrillation, persistent atrial fibrillation
- MeSH terms
- Adult, Aged, Aged, 80 and over, Atrial Fibrillation, Female, Ganglia, Heart Atria, Humans, Male, Middle Aged, Pilot Projects, Pulmonary Veins, Thoracotomy, Treatment Outcome, Catheter Ablation
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