Giuseppe De Martino1, Paolo Compagnucci2, Carmine Mancusi1, Enrico Vassallo1, Claudia Calvanese1, Giuseppe Della Ratta1, Mariateresa Librera3, Marco Franciulli4, Luigi Marino4, Antonio Dello Russo2, Michela Casella5. 1. Arrhythmology and Heart Failure Unit, Mediterranea Hospital, Naples, Italy. 2. Department of Biomedical Sciences and Public Health, Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Marche Polytechnic University, Ancona, Italy. 3. Echocardiography Laboratory, Mediterranea Hospital, Naples, Italy. 4. Cardiac Surgery Unit, Mediterranea Hospital, Naples, Italy. 5. Department of Clinical, Special, and Dental Sciences, Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Marche Polytechnic University, Ancona, Italy.
Abstract
BACKGROUND: Outcomes of catheter ablation (CA) among patients with nonparoxysmal atrial fibrillation (AF) are largely disappointing. OBJECTIVE: We sought to evaluate the feasibility, effectiveness, and safety of a single-stage stepwise endo-/epicardial approach in patients with persistent/longstanding-persistent AF. METHODS: We enrolled 25 consecutive patients with symptomatic persistent (n = 4) or longstanding-persistent (n = 21) AF and at least one prior endocardial procedure, who underwent CA using an endo-/epicardial approach. Our anatomical stepwise protocol included multiple endocardial as well as epicardial (Bachmann's bundle [BB] and ligament of Marshall ablations) components, and entailed ablation of atrial tachycardias emerging during the procedure. The primary outcome was freedom from any AF/atrial tachycardia episode after a 3-month blanking period. The secondary outcome was patients' symptom status during follow-up. RESULTS: The stepwise endo-/epicardial approach allowed sinus rhythm restoration in 72% of patients, either directly (n = 6, 24%) or after AF organization into atrial tachycardia (n = 12, 48%). BB's ablation was commonly implicated in arrhythmia termination. After a median follow-up of 266 days (interquartile range, 96 days), survival free from AF/atrial tachycardia was 88%. Antiarrhythmic drugs could be discontinued in 22 patients (88%). As compared to baseline, more patients were asymptomatic at 9-month follow-up (0% vs. 56%, p = .02). Five patients (20%) developed mild medical complications, whereas one subject (4%) had severe kidney injury requiring dialysis. CONCLUSION: A single-stage endo-/epicardial CA resulted in favorable rhythm and symptom outcomes in a cohort of patients with symptomatic persistent/longstanding-persistent AF and one or more prior endocardial procedures. Epicardial ablation of BB was commonly implicated in procedural success.
BACKGROUND: Outcomes of catheter ablation (CA) among patients with nonparoxysmal atrial fibrillation (AF) are largely disappointing. OBJECTIVE: We sought to evaluate the feasibility, effectiveness, and safety of a single-stage stepwise endo-/epicardial approach in patients with persistent/longstanding-persistent AF. METHODS: We enrolled 25 consecutive patients with symptomatic persistent (n = 4) or longstanding-persistent (n = 21) AF and at least one prior endocardial procedure, who underwent CA using an endo-/epicardial approach. Our anatomical stepwise protocol included multiple endocardial as well as epicardial (Bachmann's bundle [BB] and ligament of Marshall ablations) components, and entailed ablation of atrial tachycardias emerging during the procedure. The primary outcome was freedom from any AF/atrial tachycardia episode after a 3-month blanking period. The secondary outcome was patients' symptom status during follow-up. RESULTS: The stepwise endo-/epicardial approach allowed sinus rhythm restoration in 72% of patients, either directly (n = 6, 24%) or after AF organization into atrial tachycardia (n = 12, 48%). BB's ablation was commonly implicated in arrhythmia termination. After a median follow-up of 266 days (interquartile range, 96 days), survival free from AF/atrial tachycardia was 88%. Antiarrhythmic drugs could be discontinued in 22 patients (88%). As compared to baseline, more patients were asymptomatic at 9-month follow-up (0% vs. 56%, p = .02). Five patients (20%) developed mild medical complications, whereas one subject (4%) had severe kidney injury requiring dialysis. CONCLUSION: A single-stage endo-/epicardial CA resulted in favorable rhythm and symptom outcomes in a cohort of patients with symptomatic persistent/longstanding-persistent AF and one or more prior endocardial procedures. Epicardial ablation of BB was commonly implicated in procedural success.
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
Authors: Paolo Compagnucci; Antonio Dello Russo; Marco Bergonti; Matteo Anselmino; Giulio Zucchelli; Alessio Gasperetti; Laura Cipolletta; Giovanni Volpato; Ciro Ascione; Federico Ferraris; Yari Valeri; Maria Grazia Bongiorni; Andrea Natale; Claudio Tondo; Gaetano Maria De Ferrari; Michela Casella Journal: J Clin Med Date: 2022-03-24 Impact factor: 4.241