Konstantinos Zannis1, Wissam Alam2, Frederic A Sebag3, Thierry Folliguet4, Clement Bars5, Miche Fahed2, Julien Ternacle2, Eric Bergoend2, David Hamon2, Nicolas Lellouche2. 1. Institut Mutualiste Montsouris, Paris, France - konstantinoszannis@gmail.com. 2. Hôpital Henri Mondor, Assistance Publique Hôpitaux de Paris et INSERM U 955, Creteil, France. 3. Institut Mutualiste Montsouris, Paris, France. 4. Centre Hospitalier Régional Universitaire Brabois Universite de Lorraine, Vandoeuvre les Nancy, France. 5. Unité de Rythmologie Interventionnelle, Hôpital Saint Joseph, Marseille, France.
Abstract
BACKGROUND: Atrial fibrillation (AF) is associated with increased risk of stroke, heart failure and all-cause mortality. The Cox-Maze procedure is the most effective approach to ablate persistent AF but presents a significant morbidity and mortality. Additionally, the classical endocardial ablation approach has limited efficacy to treat long lasting persistent AF. We described a new, minimally invasive hybrid approach, combining an endocardial and epicardial ablation named convergent procedure to treat long lasting persistent AF patients. METHODS: We studied 55 consecutive patients with long lasting persistent AF who underwent the convergent procedure in 2 French centers between 2010 and 2015. All patients had at least one previous failed endocardial ablation and were highly symptomatic. Patients with a history of thoracic surgery were excluded. A 24 hour-Holter ECG was performed systematically at 3, 6 and 12 months after the convergent procedure. All patients reached 1 year follow-up. RESULTS: No death, stroke, phrenic nerve palsy or tamponade occurred immediately after the procedure. Post-surgery average length of stay was 8±4 days. Later, 3 patients (5%) developed diaphragmatic hernia resulting in a modified surgery technique. At 12 months, 76% of patients were in sinus rhythm after an average of 1.43 ablation procedure. Finally, 91% of patients were maintained on antiarrhythmic drugs. CONCLUSIONS: Thoracoscopic hybrid epicardial-endocardial ablation technique proved to be effective and safe to treat long lasting persistent AF patients with previous failed endocardial AF ablation.
BACKGROUND:Atrial fibrillation (AF) is associated with increased risk of stroke, heart failure and all-cause mortality. The Cox-Maze procedure is the most effective approach to ablate persistent AF but presents a significant morbidity and mortality. Additionally, the classical endocardial ablation approach has limited efficacy to treat long lasting persistent AF. We described a new, minimally invasive hybrid approach, combining an endocardial and epicardial ablation named convergent procedure to treat long lasting persistent AFpatients. METHODS: We studied 55 consecutive patients with long lasting persistent AF who underwent the convergent procedure in 2 French centers between 2010 and 2015. All patients had at least one previous failed endocardial ablation and were highly symptomatic. Patients with a history of thoracic surgery were excluded. A 24 hour-Holter ECG was performed systematically at 3, 6 and 12 months after the convergent procedure. All patients reached 1 year follow-up. RESULTS: No death, stroke, phrenic nerve palsy or tamponade occurred immediately after the procedure. Post-surgery average length of stay was 8±4 days. Later, 3 patients (5%) developed diaphragmatic hernia resulting in a modified surgery technique. At 12 months, 76% of patients were in sinus rhythm after an average of 1.43 ablation procedure. Finally, 91% of patients were maintained on antiarrhythmic drugs. CONCLUSIONS: Thoracoscopic hybrid epicardial-endocardial ablation technique proved to be effective and safe to treat long lasting persistent AFpatients with previous failed endocardial AF ablation.
Authors: Zefferino Palamà; Martina Nesti; Antonio Gianluca Robles; Antonio Scarà; Silvio Romano; Elena Cavarretta; Maria Penco; Pietro Delise; Mariano Rillo; Leonardo Calò; Luigi Sciarra Journal: Cardiol Res Pract Date: 2022-02-28 Impact factor: 1.990