The hybrid approach for the surgical treatment of lone atrial fibrillation: one-year results employing a monopolar radiofrequency source
Open accessAbstract
BACKGROUND: The hybrid technique combines a mono or bilateral epicardial approach with a percutaneous endocardial ablation in a single-step procedure. We present our early results with this technique employing a monopolar radiofrequency source through a right thoracoscopy in patients with lone atrial fibrillation (LAF). METHODS: Between June 2009 and December 2010 nineteen consecutive patients (mean 60.8 ± 8.6 years, 84.2% male) underwent right unilateral minimally invasive hybrid procedure for LAF at our Institution. Ten patients (52.6.6%) had long-standing persistent AF while four (21.1%) had persistent and five (26.3%) paroxysmal AF. All patients were followed-up according the Heart Rhythm Society/European Heart Rhythm Association/European Cardiac Arrhythmia Society (HRS/EHRA/ECA) and Society of Thoracic Surgeon (STS) guidelines. RESULTS: There were neither early nor late deaths. It was possible to complete all the procedures as planned without any conversion to cardiopulmonary bypass. No patient died during the follow up. At one year, 7/19 (36.8%) patients were in sinus rhythm with no episode of AF and off antiarrhythmic drugs (AAD). Time-related prevalence of postoperative AF peaked at 44.4% (41.3-47.4) at two weeks, was 30.4% (27.3-34.9) at three months, fell to 14.2% (11.6-18.1) by 6 months and was 13.3% (11.0-17.4) at 12 months Among patients with long-standing persistent (LSP) AF, 20% (2/10) were in Sinus rythm and off AAD. One-year success rates were 50% (2/4) in persistent and 60% (3/5) in paroxysmal AF. At 12 months estimated prevalence of antyarrhythmic drugs and Warfarin use were 26% (22.4-33.1) and 48% (37.2-53.2), respectively. CONCLUSIONS: One year results combining the percutaneous endocardial with the right thoracoscopic epicardial technique were, in our experience, not satisfactory, particularly in patients with LSP and persistent AF. Our findings need to be confirmed by larger studies.
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The average length of hospital stay for thoracoscopic ablation varies from 3.6 to 6.0 days.
“The average length of hospital stay for thoracoscopic ablation varies from 3.6 to 6.0 days.468,812,813”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [813]
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References 34 · Cited by 59
- Authors
- La Meir, M., Gelsomino, S., Lorusso, R., Lucà, F., Pison, L., Parise, O., Wellens, F., Gensini, G. F., & Maessen, J.
- Affiliations
- Maastricht University Medical Centre (NL)
- Universitair Ziekenhuis Brussel (BE)
- Azienda Ospedaliero-Universitaria Careggi (IT)
- Corresponding author
- Gelsomino, Sandro
- Venue
- Journal of Cardiothoracic Surgery
- Published
- 2012-07-19
- Volume
- 7
- Issue
- 1
- Pages
- 71-71
- ISSN
- 1749-8090 (ISSN-L)
- PMC
- PMC3432010
- OpenAlex
- W2136493514
- Cited by
- 59
- References
- 34
- Citations by year
- 2024: 1 · 2023: 1 · 2022: 1 · 2021: 4 · 2020: 6 · 2019: 2 · 2018: 4 · 2017: 11 · 2016: 11 · 2015: 6 · 2014: 6 · 2013: 6
- FWCI
- 3.70
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of Cardiothoracic Surgery (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Publications (Maastricht University) (publishedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- VUBIR (Vrije Universiteit Brussel) (submittedVersion)
- Research Publications (Maastricht University) (submittedVersion, cc-by)
- 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
- lone atrial fibrillation, monopolar radiofrequency ablation, epicardial ablation, long-standing persistent atrial fibrillation, paroxysmal atrial fibrillation, postoperative atrial fibrillation, antiarrhythmic drug use, warfarin, sinus rhythm maintenance
- MeSH terms
- Aged, Anti-Arrhythmia Agents, Atrial Fibrillation, Female, Humans, Male, Middle Aged, Retrospective Studies, Thoracoscopy, Warfarin, Prevalence, Catheter Ablation, Minimally Invasive Surgical Procedures
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