BACKGROUND: Catheter ablation (CA) outcomes for long-standing persistent atrial fibrillation (LSPAF) remain suboptimal. Thoracoscopic surgical ablation (SA) provides an alternative approach in this difficult to treat cohort. OBJECTIVE: To compare electrophysiological (EP) guided thoracoscopic SA with percutaneous CA as the first-line strategy in the treatment of LSPAF. METHODS: Fifty-one patients with de novo symptomatic LSPAF were recruited. Twenty-six patients underwent electrophysiologically guided thoracoscopic SA. Conduction block was tested for all lesions intraoperatively by an independent electrophysiologist. In the CA group, 25 consecutive patients underwent stepwise left atrial (LA) ablation. The primary end point was single-procedure freedom from atrial fibrillation (AF) and atrial tachycardia (AT) lasting >30 seconds without antiarrhythmic drugs at 12 months. RESULTS: Single- and multiprocedure freedom from AF/AT was higher in the SA group than in the CA group: 19 of 26 patients (73%) vs 8 of 25 patients (32%) (P = .003) and 20 of 26 patients (77%) vs 15 of 25 patients (60%) (P = .19), respectively. Testing of the SA lesion set by an electrophysiologist increased the success rate in achieving acute conduction block by 19%. In the SA group, complications were experienced by 7 of 26 patients (27%) vs 2 of 25 patients (8%) in the CA group (P = .07). CONCLUSION: In LSPAF, meticulous electrophysiologically guided thoracoscopic SA as a first-line strategy may provide excellent single-procedure success rates as compared with those of CA, but there is an increased up-front risk of nonfatal complications. Crown
BACKGROUND: Catheter ablation (CA) outcomes for long-standing persistent atrial fibrillation (LSPAF) remain suboptimal. Thoracoscopic surgical ablation (SA) provides an alternative approach in this difficult to treat cohort. OBJECTIVE: To compare electrophysiological (EP) guided thoracoscopic SA with percutaneous CA as the first-line strategy in the treatment of LSPAF. METHODS: Fifty-one patients with de novo symptomatic LSPAF were recruited. Twenty-six patients underwent electrophysiologically guided thoracoscopic SA. Conduction block was tested for all lesions intraoperatively by an independent electrophysiologist. In the CA group, 25 consecutive patients underwent stepwise left atrial (LA) ablation. The primary end point was single-procedure freedom from atrial fibrillation (AF) and atrial tachycardia (AT) lasting >30 seconds without antiarrhythmic drugs at 12 months. RESULTS: Single- and multiprocedure freedom from AF/AT was higher in the SA group than in the CA group: 19 of 26 patients (73%) vs 8 of 25 patients (32%) (P = .003) and 20 of 26 patients (77%) vs 15 of 25 patients (60%) (P = .19), respectively. Testing of the SA lesion set by an electrophysiologist increased the success rate in achieving acute conduction block by 19%. In the SA group, complications were experienced by 7 of 26 patients (27%) vs 2 of 25 patients (8%) in the CA group (P = .07). CONCLUSION: In LSPAF, meticulous electrophysiologically guided thoracoscopic SA as a first-line strategy may provide excellent single-procedure success rates as compared with those of CA, but there is an increased up-front risk of nonfatal complications. Crown
Authors: Sacha P Salzberg; Wim-Jan van Boven; Christophe Wyss; David Hürlimann; Ivano Reho; Thomas Zerm; Georg Noll; Maximilian Y Emmert; Roberto Corti; Jürg Grünenfelder Journal: J Atr Fibrillation Date: 2019-02-28
Authors: Charles M Pearman; James Redfern; Emmanuel A Williams; Richard L Snowdon; Paul Modi; Mark C S Hall; Simon Modi; Johan E P Waktare; Saagar Mahida; Derick M Todd; Neeraj Mediratta; Dhiraj Gupta Journal: Europace Date: 2019-05-01 Impact factor: 5.214
Authors: G A Haywood; R Varini; P Osmancik; M Cireddu; J Caldwell; M A Chaudhry; M Loubani; P Della Bella; E Lapenna; P Budera; M Dalrymple-Hay Journal: Int J Cardiol Heart Vasc Date: 2020-01-06
Authors: Mindy Vroomen; Bart Maesen; Justin L Luermans; Jos G Maessen; Harry J Crijns; Mark La Meir; Laurent Pison Journal: Innovations (Phila) Date: 2020-10-14
Authors: Shouvik Haldar; Habib Rehman Khan; Vennela Boyalla; Ines Kralj-Hans; Simon Jones; Joanne Lord; Oluchukwu Onyimadu; Anitha Satishkumar; Toufan Bahrami; Anthony De Souza; Jonathan R Clague; Darrel P Francis; Wajid Hussain; Julian W Jarman; David Gareth Jones; Zhong Chen; Neeraj Mediratta; Jonathan Hyde; Michael Lewis; Raad Mohiaddin; Tushar V Salukhe; Caroline Murphy; Joanna Kelly; Rajdeep S Khattar; William D Toff; Vias Markides; James McCready; Dhiraj Gupta; Tom Wong Journal: Eur Heart J Date: 2020-12-14 Impact factor: 29.983