Narendra Kumar1, Laurent Pison2, Mark La Meir3, Jos Maessen3, Harry J Crijns2. 1. Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands narendra.kumar@maastrichtuniversity.nl drnarendra007kr@gmail.com. 2. Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands. 3. Department of Cardiac Surgery, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands.
Abstract
OBJECTIVES: Bipolar radiofrequency (RF) devices are used epicardially by cardiac surgeons and cryoballoon endocardially by cardiac electrophysiologists for atrial fibrillation (AF) ablation, but in separate entities. The study's objective was to evaluate the feasibility and safety of combining an endocardial cryoballoon with epicardial bipolar RF ablation for the treatment of AF. METHODS: A cohort of 7 patients with AF underwent a hybrid thoracoscopic surgical and endocardial ablation. To prevent bilateral sequential lung deflation in these patients with severe chronic obstructive pulmonary disease, the right pulmonary veins (PVs) were isolated using an epicardial bipolar RF clamp and the contralateral veins with an endocardial cryoballoon. A box lesion set was made epicardially using a bipolar RF pen. RESULTS: Acutely, pacing manoeuvres proved a bidirectional block in all PVs in all patients. No complications were seen. A box lesion was made in 5 patients. During follow-up, 2 of them had AF recurrence: 1 was treated successfully with sotalol and another underwent redo RF catheter ablation with reisolation of the right inferior PV. At present, 6 of 7 patients are in sinus rhythm without any anti-arrythmic drugs during a follow-up of more than 40 ± 3 months. CONCLUSIONS: A hybrid approach to AF ablation using a cryoballoon endocardially and a bipolar RF device epicardially is feasible and safe.
OBJECTIVES: Bipolar radiofrequency (RF) devices are used epicardially by cardiac surgeons and cryoballoon endocardially by cardiac electrophysiologists for atrial fibrillation (AF) ablation, but in separate entities. The study's objective was to evaluate the feasibility and safety of combining an endocardial cryoballoon with epicardial bipolar RF ablation for the treatment of AF. METHODS: A cohort of 7 patients with AF underwent a hybrid thoracoscopic surgical and endocardial ablation. To prevent bilateral sequential lung deflation in these patients with severe chronic obstructive pulmonary disease, the right pulmonary veins (PVs) were isolated using an epicardial bipolar RF clamp and the contralateral veins with an endocardial cryoballoon. A box lesion set was made epicardially using a bipolar RF pen. RESULTS: Acutely, pacing manoeuvres proved a bidirectional block in all PVs in all patients. No complications were seen. A box lesion was made in 5 patients. During follow-up, 2 of them had AF recurrence: 1 was treated successfully with sotalol and another underwent redo RF catheter ablation with reisolation of the right inferior PV. At present, 6 of 7 patients are in sinus rhythm without any anti-arrythmic drugs during a follow-up of more than 40 ± 3 months. CONCLUSIONS: A hybrid approach to AF ablation using a cryoballoon endocardially and a bipolar RF device epicardially is feasible and safe.
Authors: Narendra Kumar; Pietro Bonizzi; Laurent Pison; Kevin Phan; Theo Lankveld; Bart Maesen; Bart Maessen; Mark La Meir; Sandro Gelsomino; Jos Maessen; Harry Crijns Journal: J Interv Card Electrophysiol Date: 2015-01-22 Impact factor: 1.900
Authors: N Kumar; L Pison; P Lozekoot; R Choudhury; M La Meir; S Gelsomino; H Crijns; J Maessen Journal: Neth Heart J Date: 2015-08 Impact factor: 2.380
Authors: Narendra Kumar; Trang Dinh; Mohamed Magdi Abbas; Kevin Phan; Randolph Manusama; Suzanne Philippens; Jos Maessen; Carl Timmermans Journal: Res Cardiovasc Med Date: 2015-02-20
Authors: Prabhat Kumar; Ayotunde M Bamimore; Jennifer D Schwartz; Eugene H Chung; Anil K Gehi; Andy C Kiser; James P Hummel; J Paul Mounsey Journal: J Am Heart Assoc Date: 2016-09-23 Impact factor: 5.501