The hybrid approach for the surgical treatment of lone atrial fibrillation: One-year results employing a monopolar radiofrequency source

Mark La Meir; Sandro Gelsomino; Roberto Lorusso; Fabiana Luca; Laurant Pison; Orlando Parise; Francis Wellens; Gian Franco Gensini; Jos Maessen

doi:10.1186/1749-8090-7-71

The hybrid approach for the surgical treatment of lone atrial fibrillation: One-year results employing a monopolar radiofrequency source

Mark La Meir, Sandro Gelsomino^*, Roberto Lorusso, Fabiana Luca, Laurant Pison, Orlando Parise, Francis Wellens, Gian Franco Gensini, Jos Maessen

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background: The hybrid technique combines a mono or bilateral epicardial approach with a percutaneous endocardial ablation in a single-step procedure. We present our early results with this technique employing a monopolar radiofrequency source through a right thoracoscopy in patients with lone atrial fibrillation (LAF). Methods: Between June 2009 and December 2010 nineteen consecutive patients (mean 60.8 +/- 8.6 years, 84.2% male) underwent right unilateral minimally invasive hybrid procedure for LAF at our Institution. Ten patients (52.6.6%) had long-standing persistent AF while four (21.1%) had persistent and five (26.3%) paroxysmal AF. All patients were followed-up according the Heart Rhythm Society/European Heart Rhythm Association/European Cardiac Arrhythmia Society (HRS/EHRA/ECA) and Society of Thoracic Surgeon (STS) guidelines. Results: There were neither early nor late deaths. It was possible to complete all the procedures as planned without any conversion to cardiopulmonary bypass. No patient died during the follow up. At one year, 7/19 (36.8%) patients were in sinus rhythm with no episode of AF and off antiarrhythmic drugs (AAD). Time-related prevalence of postoperative AF peaked at 44.4% (41.3-47.4) at two weeks, was 30.4% (27.3-34.9) at three months, fell to 14.2% (11.6-18.1) by 6 months and was 13.3% (11.0-17.4) at 12 months Among patients with long-standing persistent (LSP) AF, 20% (2/10) were in Sinus rythm and off AAD. One-year success rates were 50% (2/4) in persistent and 60% (3/5) in paroxysmal AF. At 12 months estimated prevalence of antyarrhythmic drugs and Warfarin use were 26% (22.4-33.1) and 48% (37.2-53.2), respectively. Conclusions: One year results combining the percutaneous endocardial with the right thoracoscopic epicardial technique were, in our experience, not satisfactory, particularly in patients with LSP and persistent AF. Our findings need to be confirmed by larger studies.

Original language	English
Pages (from-to)	71
Journal	Journal of Cardiothoracic Surgery
Volume	7
DOIs	https://doi.org/10.1186/1749-8090-7-71
Publication status	Published - 19 Jul 2012

Keywords

Atrial fibrillation
Lone atrial fibrillation
Ablation
Minimally invasive

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10.1186/1749-8090-7-71Licence: CC BY

Cite this

@article{f8e58fc27799483394f7ca4dedd45c69,

title = "The hybrid approach for the surgical treatment of lone atrial fibrillation: One-year results employing a monopolar radiofrequency source",

abstract = "Background: The hybrid technique combines a mono or bilateral epicardial approach with a percutaneous endocardial ablation in a single-step procedure. We present our early results with this technique employing a monopolar radiofrequency source through a right thoracoscopy in patients with lone atrial fibrillation (LAF). Methods: Between June 2009 and December 2010 nineteen consecutive patients (mean 60.8 +/- 8.6 years, 84.2% male) underwent right unilateral minimally invasive hybrid procedure for LAF at our Institution. Ten patients (52.6.6%) had long-standing persistent AF while four (21.1%) had persistent and five (26.3%) paroxysmal AF. All patients were followed-up according the Heart Rhythm Society/European Heart Rhythm Association/European Cardiac Arrhythmia Society (HRS/EHRA/ECA) and Society of Thoracic Surgeon (STS) guidelines. Results: There were neither early nor late deaths. It was possible to complete all the procedures as planned without any conversion to cardiopulmonary bypass. No patient died during the follow up. At one year, 7/19 (36.8%) patients were in sinus rhythm with no episode of AF and off antiarrhythmic drugs (AAD). Time-related prevalence of postoperative AF peaked at 44.4% (41.3-47.4) at two weeks, was 30.4% (27.3-34.9) at three months, fell to 14.2% (11.6-18.1) by 6 months and was 13.3% (11.0-17.4) at 12 months Among patients with long-standing persistent (LSP) AF, 20% (2/10) were in Sinus rythm and off AAD. One-year success rates were 50% (2/4) in persistent and 60% (3/5) in paroxysmal AF. At 12 months estimated prevalence of antyarrhythmic drugs and Warfarin use were 26% (22.4-33.1) and 48% (37.2-53.2), respectively. Conclusions: One year results combining the percutaneous endocardial with the right thoracoscopic epicardial technique were, in our experience, not satisfactory, particularly in patients with LSP and persistent AF. Our findings need to be confirmed by larger studies.",

keywords = "Atrial fibrillation, Lone atrial fibrillation, Ablation, Minimally invasive",

author = "{La Meir}, Mark and Sandro Gelsomino and Roberto Lorusso and Fabiana Luca and Laurant Pison and Orlando Parise and Francis Wellens and Gensini, {Gian Franco} and Jos Maessen",

year = "2012",

month = jul,

day = "19",

doi = "10.1186/1749-8090-7-71",

language = "English",

volume = "7",

pages = "71",

journal = "Journal of Cardiothoracic Surgery",

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publisher = "BioMed Central",

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TY - JOUR

T1 - The hybrid approach for the surgical treatment of lone atrial fibrillation: One-year results employing a monopolar radiofrequency source

AU - La Meir, Mark

AU - Gelsomino, Sandro

AU - Lorusso, Roberto

AU - Luca, Fabiana

AU - Pison, Laurant

AU - Parise, Orlando

AU - Wellens, Francis

AU - Gensini, Gian Franco

AU - Maessen, Jos

PY - 2012/7/19

Y1 - 2012/7/19

N2 - Background: The hybrid technique combines a mono or bilateral epicardial approach with a percutaneous endocardial ablation in a single-step procedure. We present our early results with this technique employing a monopolar radiofrequency source through a right thoracoscopy in patients with lone atrial fibrillation (LAF). Methods: Between June 2009 and December 2010 nineteen consecutive patients (mean 60.8 +/- 8.6 years, 84.2% male) underwent right unilateral minimally invasive hybrid procedure for LAF at our Institution. Ten patients (52.6.6%) had long-standing persistent AF while four (21.1%) had persistent and five (26.3%) paroxysmal AF. All patients were followed-up according the Heart Rhythm Society/European Heart Rhythm Association/European Cardiac Arrhythmia Society (HRS/EHRA/ECA) and Society of Thoracic Surgeon (STS) guidelines. Results: There were neither early nor late deaths. It was possible to complete all the procedures as planned without any conversion to cardiopulmonary bypass. No patient died during the follow up. At one year, 7/19 (36.8%) patients were in sinus rhythm with no episode of AF and off antiarrhythmic drugs (AAD). Time-related prevalence of postoperative AF peaked at 44.4% (41.3-47.4) at two weeks, was 30.4% (27.3-34.9) at three months, fell to 14.2% (11.6-18.1) by 6 months and was 13.3% (11.0-17.4) at 12 months Among patients with long-standing persistent (LSP) AF, 20% (2/10) were in Sinus rythm and off AAD. One-year success rates were 50% (2/4) in persistent and 60% (3/5) in paroxysmal AF. At 12 months estimated prevalence of antyarrhythmic drugs and Warfarin use were 26% (22.4-33.1) and 48% (37.2-53.2), respectively. Conclusions: One year results combining the percutaneous endocardial with the right thoracoscopic epicardial technique were, in our experience, not satisfactory, particularly in patients with LSP and persistent AF. Our findings need to be confirmed by larger studies.

AB - Background: The hybrid technique combines a mono or bilateral epicardial approach with a percutaneous endocardial ablation in a single-step procedure. We present our early results with this technique employing a monopolar radiofrequency source through a right thoracoscopy in patients with lone atrial fibrillation (LAF). Methods: Between June 2009 and December 2010 nineteen consecutive patients (mean 60.8 +/- 8.6 years, 84.2% male) underwent right unilateral minimally invasive hybrid procedure for LAF at our Institution. Ten patients (52.6.6%) had long-standing persistent AF while four (21.1%) had persistent and five (26.3%) paroxysmal AF. All patients were followed-up according the Heart Rhythm Society/European Heart Rhythm Association/European Cardiac Arrhythmia Society (HRS/EHRA/ECA) and Society of Thoracic Surgeon (STS) guidelines. Results: There were neither early nor late deaths. It was possible to complete all the procedures as planned without any conversion to cardiopulmonary bypass. No patient died during the follow up. At one year, 7/19 (36.8%) patients were in sinus rhythm with no episode of AF and off antiarrhythmic drugs (AAD). Time-related prevalence of postoperative AF peaked at 44.4% (41.3-47.4) at two weeks, was 30.4% (27.3-34.9) at three months, fell to 14.2% (11.6-18.1) by 6 months and was 13.3% (11.0-17.4) at 12 months Among patients with long-standing persistent (LSP) AF, 20% (2/10) were in Sinus rythm and off AAD. One-year success rates were 50% (2/4) in persistent and 60% (3/5) in paroxysmal AF. At 12 months estimated prevalence of antyarrhythmic drugs and Warfarin use were 26% (22.4-33.1) and 48% (37.2-53.2), respectively. Conclusions: One year results combining the percutaneous endocardial with the right thoracoscopic epicardial technique were, in our experience, not satisfactory, particularly in patients with LSP and persistent AF. Our findings need to be confirmed by larger studies.

KW - Atrial fibrillation

KW - Lone atrial fibrillation

KW - Ablation

KW - Minimally invasive

U2 - 10.1186/1749-8090-7-71

DO - 10.1186/1749-8090-7-71

M3 - Article

SN - 1749-8090

VL - 7

SP - 71

JO - Journal of Cardiothoracic Surgery

JF - Journal of Cardiothoracic Surgery

ER -