The first experience of a hybrid approach in the surgical treatment of atrial fibrillation
Background: Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and is associated with an increased risk of death, progression of heart failure, and the development of cardiogenic thromboemboli. Despite the significant success in the management of AF in the paroxysmal form, t...
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| Format: | Article |
| Language: | English |
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Eco-vector
2023-01-01
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| Series: | Клиническая практика |
| Subjects: | |
| Online Access: | https://journals.eco-vector.com/clinpractice/article/viewFile/116052/pdf |
| _version_ | 1797847419760672768 |
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| author | Aleksandr S. Zotov Igor A. Khamnagadaev Emil R. Sakharov Oleg O. Shelest Leonid A. Belousov Mikhail L. Kokov Marina S. Michurova Irina A. Bulavina Robert I. Khabazov Natalya G. Mokrysheva Aleksandr V. Troitskiy |
| author_facet | Aleksandr S. Zotov Igor A. Khamnagadaev Emil R. Sakharov Oleg O. Shelest Leonid A. Belousov Mikhail L. Kokov Marina S. Michurova Irina A. Bulavina Robert I. Khabazov Natalya G. Mokrysheva Aleksandr V. Troitskiy |
| author_sort | Aleksandr S. Zotov |
| collection | DOAJ |
| description | Background: Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and is associated with an increased risk of death, progression of heart failure, and the development of cardiogenic thromboemboli. Despite the significant success in the management of AF in the paroxysmal form, the results of the treatment for patients with persistent forms of AF remain unsatisfactory. Though the surgical approach provides higher rates of efficiency regarding the restoration of a sinus rhythm, transmural lesions are not always attainable, as a result, the rate of AF recurrence in the long-term period remains fairly high. It is also impossible to create ablative patterns to the mitral and tricuspid valves during thoracoscopic epicardial ablation, which can cause the development of recurrent AF, perimitral and typical atrial flutter. Therefore, the development of hybrid approaches combining the advantages of catheter and thoracoscopic techniques is an urgent task of contemporary surgical and interventional arrhythmology.
Aims: to estimate the immediate results of a hybrid approach in the management of patients with persistent AF.
Methods: We report the first experience of a hybrid treatment of patients with persistent AF. 6 patients aged 53-64 years (1 female, 5 males) were included in the study. At the first stage, thoracoscopic epicardial bipolar ablation was performed (modified GALAXY protocol); the second stage (in 3 to 6 months after the thoracoscopic stage) included an intracardiac electrophysiological study with three-dimensional endocardial mapping followed by endocardial ablation.
Results: The thoracoscopic stage of the hybrid treatment included ablation according to the box lesion scheme using a bipolar irrigation equipment. No lethal outcomes and severe, life-threatening complications were registered. The duration of the inpatient period was 510 hospital-days. The 2nd stage of the hybrid treatment was limited to intracardiac electrophysiological examination only in 2 patients. In 4 patients, epicardial radiofrequency ablation was complemented by endocardial radiofrequency exposure. In 3 of the 4 patients who underwent endocardial radiofrequency ablation, catheter ablation of the mitral and cavotricuspid isthmus was required because of the induction of perimitral and typical flutter, respectively. After the 2nd stage of the hybrid treatment, at the time of discharge all the patients maintained a stable sinus rhythm. There were no severe complications or lethal outcomes.
Conclusion: a hybrid approach in the AF management is a safe and effective method of treatment, which combines the advantages of minimally invasive surgery and endocardial intervention in patients with persistent AF. The technique is safe and has acceptable short-term results. |
| first_indexed | 2024-04-09T18:12:19Z |
| format | Article |
| id | doaj.art-442325a86deb4e40b2e95a7be39a050a |
| institution | Directory Open Access Journal |
| issn | 2220-3095 2618-8627 |
| language | English |
| last_indexed | 2024-04-09T18:12:19Z |
| publishDate | 2023-01-01 |
| publisher | Eco-vector |
| record_format | Article |
| series | Клиническая практика |
| spelling | doaj.art-442325a86deb4e40b2e95a7be39a050a2023-04-13T14:41:31ZengEco-vectorКлиническая практика2220-30952618-86272023-01-01134385010.17816/clinpract11605278351The first experience of a hybrid approach in the surgical treatment of atrial fibrillationAleksandr S. Zotov0https://orcid.org/0000-0003-0494-0211Igor A. Khamnagadaev1https://orcid.org/0000-0002-9247-4523Emil R. Sakharov2https://orcid.org/0000-0003-1057-2777Oleg O. Shelest3https://orcid.org/0000-0002-0087-9049Leonid A. Belousov4https://orcid.org/0000-0003-4917-1743Mikhail L. Kokov5https://orcid.org/0000-0003-4766-5213Marina S. Michurova6https://orcid.org/0000-0003-1495-5847Irina A. Bulavina7https://orcid.org/0000-0002-6267-3724Robert I. Khabazov8https://orcid.org/0000-0001-6801-6568Natalya G. Mokrysheva9https://orcid.org/0000-0002-9717-9742Aleksandr V. Troitskiy10https://orcid.org/0000-0003-2143-8696Federal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological AgencyEndocrinology Research CentreFederal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological AgencyFederal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological AgencyEndocrinology Research CentreRussian State Agrarian University — Moscow Timiryazev Agricultural AcademyEndocrinology Research CentreBuyanov City Clinical HospitalFederal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological AgencyEndocrinology Research CentreFederal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological AgencyBackground: Atrial fibrillation (AF) is the most common arrhythmia in clinical practice and is associated with an increased risk of death, progression of heart failure, and the development of cardiogenic thromboemboli. Despite the significant success in the management of AF in the paroxysmal form, the results of the treatment for patients with persistent forms of AF remain unsatisfactory. Though the surgical approach provides higher rates of efficiency regarding the restoration of a sinus rhythm, transmural lesions are not always attainable, as a result, the rate of AF recurrence in the long-term period remains fairly high. It is also impossible to create ablative patterns to the mitral and tricuspid valves during thoracoscopic epicardial ablation, which can cause the development of recurrent AF, perimitral and typical atrial flutter. Therefore, the development of hybrid approaches combining the advantages of catheter and thoracoscopic techniques is an urgent task of contemporary surgical and interventional arrhythmology. Aims: to estimate the immediate results of a hybrid approach in the management of patients with persistent AF. Methods: We report the first experience of a hybrid treatment of patients with persistent AF. 6 patients aged 53-64 years (1 female, 5 males) were included in the study. At the first stage, thoracoscopic epicardial bipolar ablation was performed (modified GALAXY protocol); the second stage (in 3 to 6 months after the thoracoscopic stage) included an intracardiac electrophysiological study with three-dimensional endocardial mapping followed by endocardial ablation. Results: The thoracoscopic stage of the hybrid treatment included ablation according to the box lesion scheme using a bipolar irrigation equipment. No lethal outcomes and severe, life-threatening complications were registered. The duration of the inpatient period was 510 hospital-days. The 2nd stage of the hybrid treatment was limited to intracardiac electrophysiological examination only in 2 patients. In 4 patients, epicardial radiofrequency ablation was complemented by endocardial radiofrequency exposure. In 3 of the 4 patients who underwent endocardial radiofrequency ablation, catheter ablation of the mitral and cavotricuspid isthmus was required because of the induction of perimitral and typical flutter, respectively. After the 2nd stage of the hybrid treatment, at the time of discharge all the patients maintained a stable sinus rhythm. There were no severe complications or lethal outcomes. Conclusion: a hybrid approach in the AF management is a safe and effective method of treatment, which combines the advantages of minimally invasive surgery and endocardial intervention in patients with persistent AF. The technique is safe and has acceptable short-term results.https://journals.eco-vector.com/clinpractice/article/viewFile/116052/pdfablation techniqueatrial fibrillationsurgerythoracoscopic ablationhybrid approach |
| spellingShingle | Aleksandr S. Zotov Igor A. Khamnagadaev Emil R. Sakharov Oleg O. Shelest Leonid A. Belousov Mikhail L. Kokov Marina S. Michurova Irina A. Bulavina Robert I. Khabazov Natalya G. Mokrysheva Aleksandr V. Troitskiy The first experience of a hybrid approach in the surgical treatment of atrial fibrillation Клиническая практика ablation technique atrial fibrillation surgery thoracoscopic ablation hybrid approach |
| title | The first experience of a hybrid approach in the surgical treatment of atrial fibrillation |
| title_full | The first experience of a hybrid approach in the surgical treatment of atrial fibrillation |
| title_fullStr | The first experience of a hybrid approach in the surgical treatment of atrial fibrillation |
| title_full_unstemmed | The first experience of a hybrid approach in the surgical treatment of atrial fibrillation |
| title_short | The first experience of a hybrid approach in the surgical treatment of atrial fibrillation |
| title_sort | first experience of a hybrid approach in the surgical treatment of atrial fibrillation |
| topic | ablation technique atrial fibrillation surgery thoracoscopic ablation hybrid approach |
| url | https://journals.eco-vector.com/clinpractice/article/viewFile/116052/pdf |
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