Epicardial, Biatrial Ablation With Integrated Uni-bipolar Radiofrequency Technology in Stand-alone Persistent Atrial Fibrillation

Fabrizio Rosati, Claudio Muneretto, Elisa Merati, Gianluca Polvani, Massimo Moltrasio, Claudio Tondo, Antonio Curnis, Manuel Cerini, Alexandre Metras, Gianluigi Bisleri

Research output: Contribution to journalArticle

Abstract

OBJECTIVE: Although minimally invasive approaches for surgical treatment of stand-alone atrial fibrillation have gained popularity for the past decade, ablation technology and extensive lesion sets play a major role in the achievement of a successful procedure, especially in presence of persistent and long-standing persistent atrial fibrillation. We evaluated clinical outcomes after totally endoscopic biatrial epicardial ablation of persistent atrial fibrillation with a novel integrated uni-bipolar radiofrequency device.

METHODS: Forty-nine (49) consecutive patients with stand-alone atrial fibrillation underwent right-sided monolateral thoracoscopic surgical ablation with a novel integrated uni-bipolar radiofrequency energy delivery and temperature-controlled technology. Atrial fibrillation was persistent in 13 (26.5%) of 49 and long-standing persistent in 36 (73.5%) of 49 patients. Mean ± SD age was 60.6 ± 10.3 years. Median duration of atrial fibrillation was 74 months. Mean ± SD left atrial diameter was 44.7 ± 4.0 mm.

RESULTS: Epicardial en bloc isolation of all pulmonary veins (box lesion) and additional ablation of the right atrial free wall was successfully performed via minimally invasive approach without any intraoperative and postoperative major complications. Intraoperative entrance and exit block was achieved in 77.5% (38/49) and 91.8% (45/49) of patients, respectively. Mean ± SD ablation time was 16.3 ± 4.8 minutes. No intensive care unit stay was required. Postoperative sinus rhythm was achieved in 93.8% (30/32) patients, and no pacemaker implantation was required. At 13 months, 87.7% (43/49) of patients were in sinus rhythm; 71.4% (35/49) were free from antiarrhythmic drugs and 75.5% (37/49) from oral anticoagulation.

CONCLUSIONS: Integrated uni-bipolar radiofrequency ablation technology showed to be effective for the surgical treatment of atrial fibrillation with a total endoscopic approach. A versapolar suction device with extensive right-left atrial lesion set may further improve outcomes in patients with nonparoxysmal atrial fibrillation.

Original languageEnglish
Pages (from-to)114-119
Number of pages6
JournalInnovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Volume13
Issue number2
DOIs
Publication statusPublished - Apr 27 2018

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Atrial Fibrillation
Technology
Equipment and Supplies
Pulmonary Veins
Anti-Arrhythmia Agents
Suction
Intensive Care Units
Temperature
Therapeutics

Keywords

  • Aged
  • Atrial Appendage/anatomy & histology
  • Atrial Fibrillation/physiopathology
  • Catheter Ablation/instrumentation
  • Endoscopy/instrumentation
  • Female
  • Follow-Up Studies
  • Heart Atria/physiopathology
  • Humans
  • Intraoperative Complications/epidemiology
  • Male
  • Middle Aged
  • Minimally Invasive Surgical Procedures/statistics & numerical data
  • Pericardium/surgery
  • Postoperative Period
  • Prospective Studies
  • Pulmonary Veins/surgery
  • Thoracoscopy/methods
  • Treatment Outcome

Cite this

Epicardial, Biatrial Ablation With Integrated Uni-bipolar Radiofrequency Technology in Stand-alone Persistent Atrial Fibrillation. / Rosati, Fabrizio; Muneretto, Claudio; Merati, Elisa; Polvani, Gianluca; Moltrasio, Massimo; Tondo, Claudio; Curnis, Antonio; Cerini, Manuel; Metras, Alexandre; Bisleri, Gianluigi.

In: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, Vol. 13, No. 2, 27.04.2018, p. 114-119.

Research output: Contribution to journalArticle

Rosati, Fabrizio ; Muneretto, Claudio ; Merati, Elisa ; Polvani, Gianluca ; Moltrasio, Massimo ; Tondo, Claudio ; Curnis, Antonio ; Cerini, Manuel ; Metras, Alexandre ; Bisleri, Gianluigi. / Epicardial, Biatrial Ablation With Integrated Uni-bipolar Radiofrequency Technology in Stand-alone Persistent Atrial Fibrillation. In: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery. 2018 ; Vol. 13, No. 2. pp. 114-119.
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abstract = "OBJECTIVE: Although minimally invasive approaches for surgical treatment of stand-alone atrial fibrillation have gained popularity for the past decade, ablation technology and extensive lesion sets play a major role in the achievement of a successful procedure, especially in presence of persistent and long-standing persistent atrial fibrillation. We evaluated clinical outcomes after totally endoscopic biatrial epicardial ablation of persistent atrial fibrillation with a novel integrated uni-bipolar radiofrequency device.METHODS: Forty-nine (49) consecutive patients with stand-alone atrial fibrillation underwent right-sided monolateral thoracoscopic surgical ablation with a novel integrated uni-bipolar radiofrequency energy delivery and temperature-controlled technology. Atrial fibrillation was persistent in 13 (26.5{\%}) of 49 and long-standing persistent in 36 (73.5{\%}) of 49 patients. Mean ± SD age was 60.6 ± 10.3 years. Median duration of atrial fibrillation was 74 months. Mean ± SD left atrial diameter was 44.7 ± 4.0 mm.RESULTS: Epicardial en bloc isolation of all pulmonary veins (box lesion) and additional ablation of the right atrial free wall was successfully performed via minimally invasive approach without any intraoperative and postoperative major complications. Intraoperative entrance and exit block was achieved in 77.5{\%} (38/49) and 91.8{\%} (45/49) of patients, respectively. Mean ± SD ablation time was 16.3 ± 4.8 minutes. No intensive care unit stay was required. Postoperative sinus rhythm was achieved in 93.8{\%} (30/32) patients, and no pacemaker implantation was required. At 13 months, 87.7{\%} (43/49) of patients were in sinus rhythm; 71.4{\%} (35/49) were free from antiarrhythmic drugs and 75.5{\%} (37/49) from oral anticoagulation.CONCLUSIONS: Integrated uni-bipolar radiofrequency ablation technology showed to be effective for the surgical treatment of atrial fibrillation with a total endoscopic approach. A versapolar suction device with extensive right-left atrial lesion set may further improve outcomes in patients with nonparoxysmal atrial fibrillation.",
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T1 - Epicardial, Biatrial Ablation With Integrated Uni-bipolar Radiofrequency Technology in Stand-alone Persistent Atrial Fibrillation

AU - Rosati, Fabrizio

AU - Muneretto, Claudio

AU - Merati, Elisa

AU - Polvani, Gianluca

AU - Moltrasio, Massimo

AU - Tondo, Claudio

AU - Curnis, Antonio

AU - Cerini, Manuel

AU - Metras, Alexandre

AU - Bisleri, Gianluigi

PY - 2018/4/27

Y1 - 2018/4/27

N2 - OBJECTIVE: Although minimally invasive approaches for surgical treatment of stand-alone atrial fibrillation have gained popularity for the past decade, ablation technology and extensive lesion sets play a major role in the achievement of a successful procedure, especially in presence of persistent and long-standing persistent atrial fibrillation. We evaluated clinical outcomes after totally endoscopic biatrial epicardial ablation of persistent atrial fibrillation with a novel integrated uni-bipolar radiofrequency device.METHODS: Forty-nine (49) consecutive patients with stand-alone atrial fibrillation underwent right-sided monolateral thoracoscopic surgical ablation with a novel integrated uni-bipolar radiofrequency energy delivery and temperature-controlled technology. Atrial fibrillation was persistent in 13 (26.5%) of 49 and long-standing persistent in 36 (73.5%) of 49 patients. Mean ± SD age was 60.6 ± 10.3 years. Median duration of atrial fibrillation was 74 months. Mean ± SD left atrial diameter was 44.7 ± 4.0 mm.RESULTS: Epicardial en bloc isolation of all pulmonary veins (box lesion) and additional ablation of the right atrial free wall was successfully performed via minimally invasive approach without any intraoperative and postoperative major complications. Intraoperative entrance and exit block was achieved in 77.5% (38/49) and 91.8% (45/49) of patients, respectively. Mean ± SD ablation time was 16.3 ± 4.8 minutes. No intensive care unit stay was required. Postoperative sinus rhythm was achieved in 93.8% (30/32) patients, and no pacemaker implantation was required. At 13 months, 87.7% (43/49) of patients were in sinus rhythm; 71.4% (35/49) were free from antiarrhythmic drugs and 75.5% (37/49) from oral anticoagulation.CONCLUSIONS: Integrated uni-bipolar radiofrequency ablation technology showed to be effective for the surgical treatment of atrial fibrillation with a total endoscopic approach. A versapolar suction device with extensive right-left atrial lesion set may further improve outcomes in patients with nonparoxysmal atrial fibrillation.

AB - OBJECTIVE: Although minimally invasive approaches for surgical treatment of stand-alone atrial fibrillation have gained popularity for the past decade, ablation technology and extensive lesion sets play a major role in the achievement of a successful procedure, especially in presence of persistent and long-standing persistent atrial fibrillation. We evaluated clinical outcomes after totally endoscopic biatrial epicardial ablation of persistent atrial fibrillation with a novel integrated uni-bipolar radiofrequency device.METHODS: Forty-nine (49) consecutive patients with stand-alone atrial fibrillation underwent right-sided monolateral thoracoscopic surgical ablation with a novel integrated uni-bipolar radiofrequency energy delivery and temperature-controlled technology. Atrial fibrillation was persistent in 13 (26.5%) of 49 and long-standing persistent in 36 (73.5%) of 49 patients. Mean ± SD age was 60.6 ± 10.3 years. Median duration of atrial fibrillation was 74 months. Mean ± SD left atrial diameter was 44.7 ± 4.0 mm.RESULTS: Epicardial en bloc isolation of all pulmonary veins (box lesion) and additional ablation of the right atrial free wall was successfully performed via minimally invasive approach without any intraoperative and postoperative major complications. Intraoperative entrance and exit block was achieved in 77.5% (38/49) and 91.8% (45/49) of patients, respectively. Mean ± SD ablation time was 16.3 ± 4.8 minutes. No intensive care unit stay was required. Postoperative sinus rhythm was achieved in 93.8% (30/32) patients, and no pacemaker implantation was required. At 13 months, 87.7% (43/49) of patients were in sinus rhythm; 71.4% (35/49) were free from antiarrhythmic drugs and 75.5% (37/49) from oral anticoagulation.CONCLUSIONS: Integrated uni-bipolar radiofrequency ablation technology showed to be effective for the surgical treatment of atrial fibrillation with a total endoscopic approach. A versapolar suction device with extensive right-left atrial lesion set may further improve outcomes in patients with nonparoxysmal atrial fibrillation.

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KW - Atrial Appendage/anatomy & histology

KW - Atrial Fibrillation/physiopathology

KW - Catheter Ablation/instrumentation

KW - Endoscopy/instrumentation

KW - Female

KW - Follow-Up Studies

KW - Heart Atria/physiopathology

KW - Humans

KW - Intraoperative Complications/epidemiology

KW - Male

KW - Middle Aged

KW - Minimally Invasive Surgical Procedures/statistics & numerical data

KW - Pericardium/surgery

KW - Postoperative Period

KW - Prospective Studies

KW - Pulmonary Veins/surgery

KW - Thoracoscopy/methods

KW - Treatment Outcome

U2 - 10.1097/IMI.0000000000000482

DO - 10.1097/IMI.0000000000000482

M3 - Article

C2 - 29697597

VL - 13

SP - 114

EP - 119

JO - Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery

JF - Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery

SN - 1556-9845

IS - 2

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