Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
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Mid-Term Results of Totally Thoracoscopic Ablation in Patients with Recurrent Atrial Fibrillation after Catheter Ablation

  • Lim, Suk Kyung (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Joo Yeon (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • On, Young Keun (Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jeong, Dong Seop (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2019.08.08
  • Accepted : 2020.04.12
  • Published : 2020.10.30
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Abstract

Background: We investigated the impact of previous catheter ablation (CA) on the midterm outcomes of totally thoracoscopic ablation in patients with lone atrial fibrillation (AF). Methods: Between February 2012 and July 2018, 332 patients underwent totally thoracoscopic ablation for the treatment of AF (persistent AF; n=264, 80%). The patients were stratified into CA (n=47, 14%) and non-CA (nCA; n=285, 86%) groups according to their CA history. Results: All the baseline clinical characteristics and risk factors were similar between the groups except for age, percentage of male patients, prevalence of paroxysmal AF, prior percutaneous coronary intervention, and left atrial volume index (LAVI). No significant intergroup differences were observed in the incidence of early and late complications. At late follow-up, normal sinus rhythm was observed in 92% (43 of 47) of the patients in the CA group and 85% (242 of 285) of the patients in the nCA group (p=0.268). The rate of freedom from AF recurrence at 5 years was 55.3%±11.0% in the CA group, which was similar to that in the nCA group (55.7%±5.1%, p=0.690). In Cox regression analysis, preoperative brain natriuretic peptide levels and LAVI were associated with AF recurrence, but CA history was not significant. Conclusion: Totally thoracoscopic ablation was safe and effective in treating AF irrespective of CA history. A history of CA did not appear to affect the procedural complexity.

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References

  1. Heeringa J, van der Kuip DA, Hofman A, et al. Prevalence, incidence and lifetime risk of atrial fibrillation: the Rotterdam study. Eur Heart J 2006;27:949-53. https://doi.org/10.1093/eurheartj/ehi825
  2. Sultan A, Luker J, Andresen D, et al. Predictors of atrial fibrillation recurrence after catheter ablation: data from the German ablation registry. Sci Rep 2017;7:16678. https://doi.org/10.1038/s41598-017-16938-6
  3. Solheim E, Hoff PI, Off MK, Ohm OJ, Chen J. Significance of late recurrence of atrial fibrillation during long-term follow-up after pulmonary vein isolation. Pacing Clin Electrophysiol 2007;30 Suppl 1:S108-11.
  4. Bottoni N, Bertaglia E, Donateo P, et al. Long-term clinical outcome of patients who failed catheter ablation of atrial fibrillation. Europace 2015;17:403-8. https://doi.org/10.1093/europace/euu229
  5. Darby AE. Recurrent atrial fibrillation after catheter ablation: considerations for repeat ablation and strategies to optimize success. J Atr Fibrillation 2016;9:1427.
  6. Kobza R, Hindricks G, Tanner H, et al. Late recurrent arrhythmias after ablation of atrial fibrillation: incidence, mechanisms, and treatment. Heart Rhythm 2004;1:676-83. https://doi.org/10.1016/j.hrthm.2004.08.009
  7. La Meir M. New technologies and hybrid surgery for atrial fibrillation. Rambam Maimonides Med J 2013;4:e0016. https://doi.org/10.5041/RMMJ.10116
  8. Verma A, Kilicaslan F, Pisano E, et al. Response of atrial fibrillation to pulmonary vein antrum isolation is directly related to resumption and delay of pulmonary vein conduction. Circulation 2005;112:627-35. https://doi.org/10.1161/CIRCULATIONAHA.104.533190
  9. Rostock T, Steven D, Hoffmann B, et al. Chronic atrial fibrillation is a biatrial arrhythmia: data from catheter ablation of chronic atrial fibrillation aiming arrhythmia termination using a sequential ablation approach. Circ Arrhythm Electrophysiol 2008;1:344-53. https://doi.org/10.1161/CIRCEP.108.772392
  10. On YK, Park KM, Jeong DS, et al. Electrophysiologic results after thoracoscopic ablation for chronic atrial fibrillation. Ann Thorac Surg 2015;100:1595-602. https://doi.org/10.1016/j.athoracsur.2015.04.127
  11. Wolf RK, Schneeberger EW, Osterday R, et al. Video-assisted bilateral pulmonary vein isolation and left atrial appendage exclusion for atrial fibrillation. J Thorac Cardiovasc Surg 2005;130:797-802. https://doi.org/10.1016/j.jtcvs.2005.03.041
  12. Cheniti G, Vlachos K, Pambrun T, et al. Atrial fibrillation mechanisms and implications for catheter ablation. Front Physiol 2018;9:1458. https://doi.org/10.3389/fphys.2018.01458
  13. Oakes RS, Badger TJ, Kholmovski EG, et al. Detection and quantification of left atrial structural remodeling with delayed-enhancement magnetic resonance imaging in patients with atrial fibrillation. Circulation 2009;119:1758-67. https://doi.org/10.1161/CIRCULATIONAHA.108.811877
  14. Nuhrich JM, Geisler AC, Steven D, et al. Active atrial function and atrial scar burden after multiple catheter ablations of persistent atrial fibrillation. Pacing Clin Electrophysiol 2017;40:175-82. https://doi.org/10.1111/pace.13004
  15. Boersma LV, Castella M, van Boven W, et al. Atrial fibrillation catheter ablation versus surgical ablation treatment (FAST): a 2-center randomized clinical trial. Circulation 2012;125:23-30. https://doi.org/10.1161/CIRCULATIONAHA.111.074047
  16. Castella M, Kotecha D, van Laar C, et al. Thoracoscopic vs. catheter ablation for atrial fibrillation: long-term follow-up of the FAST randomized trial. Europace 2019;21:746-53. https://doi.org/10.1093/europace/euy325
  17. Hwang C, Chen PS. Ligament of Marshall: why it is important for atrial fibrillation ablation. Heart Rhythm 2009;6(12 Suppl):S35-40. https://doi.org/10.1016/j.hrthm.2009.08.034
  18. Saba S. Left atrial appendage closure: killing 2 birds with 1 stone? J Am Heart Assoc 2015;4:e002028. https://doi.org/10.1161/JAHA.115.002028
  19. Hwang JK, Jeong DS, Gwag HB, et al. Staged hybrid procedure versus radiofrequency catheter ablation in the treatment of atrial fibrillation. PLoS One 2018;13:e0205431. https://doi.org/10.1371/journal.pone.0205431
  20. De Asmundis C, Chierchia GB, Mugnai G, et al. Midterm clinical outcomes of concomitant thoracoscopic epicardial and transcatheter endocardial ablation for persistent and long-standing persistent atrial fibrillation: a single-centre experience. Europace 2017;19:58-65. https://doi.org/10.1093/europace/euw026