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Laser Ablation Of Atrial Fibrillation: Mid-term Clinical Experience
Li Poa1, Miguel Puig1, Pablo Zubiate1
1Cardiac Surgery, Enloe Heart Program, Enloe Medical Center, Chico, California, USA.
Insights
Laser ablation safely and effectively treats atrial fibrillation (AF), achieving normal sinus rhythm in 84.6% of patients. This minimally invasive approach offers a promising alternative for AF management.
Area of Science:
- Cardiology
- Minimally Invasive Surgery
Background:
- Atrial Fibrillation (AF) significantly increases stroke risk in older adults.
- The traditional Cox MAZE procedure is effective but highly invasive.
- Minimally invasive ablation strategies are emerging for AF management.
Purpose of the Study:
- To report clinical experience with laser energy ablation for Atrial Fibrillation (AF).
- To evaluate the safety and efficacy of laser ablation in AF patients.
Main Methods:
- Fifty-two consecutive AF patients underwent laser ablation (concomitant or isolated).
- Procedures included pulmonary vein isolation, ganglionectomies, and IVC/isthmus ablation.
- Additional procedures: left atrial appendage ligation, ligament of Marshall resection, mitral annular lesions.
Main Results:
- At a median 250-day follow-up, 84.6% (44/52) of patients maintained normal sinus rhythm (NSR).
- No complications or mortality were reported related to the laser ablation procedure.
Conclusions:
- Laser ablation is a safe and effective option for endocardial and epicardial AF treatment.
- The two-port thoracoscopic approach is suitable for concomitant and lone AF ablation.
Abstract:
Background: Atrial Fibrillation is known to account for one third of all the strokes caused in the US in the population above the age of 70. Patients treated with the surgical Cox MAZE operation have been shown to have a 150 fold decrease in the incidence of stroke over an 18 year period. However, the original Cox MAZE although extremely successful in treating atrial fibrillation and decreasing the incidence of strokes was not performed widely because of complexity and invasiveness of the procedure. A variety of alternative energy based curative ablation strategies are now available for more minimally invasive therapeutic management of atrial fibrillation (AF). In this communication, we report our clinical experience in AF therapy utilizing laser energy ablation technology. Methods: Fifty two consecutive AF patients underwent concomitant or isolated ablation prior to any coexisting cardiac procedures that included CABG (coronary artery bypass surgery, MV (mitral valve) or AV (aortic valve) repairs. All patients had an epicardially based ablation pattern with basic lesions being en bloc box type pulmonary vein isolation which included the antral surface of the left atrium, directed ganglionectomies of the the right anterior and inferior ganglions, posteriomedial ablation of the IVC ( inferior vena cava), and a right isthmus ablation. Twenty seven patients had ligation of their left atrial appendage, 14 patients had resection of the ligament of Marshall, and three patients had endocardial placed lesions of a mitral annular connecting type lesion. In order to maintain the patients in normal sinus rhythm (NSR), electrical cardioversion and anti-arrhythmic drugs were employed as required. Results: At a median follow-up of 250 days, 44 of the total 52 patients (84.6%) exhibited NSR.. No complications or mortality were reported due to the laser procedure. Conclusion: Laser ablation was successfully and safely used for endocardial and epicardial AF ablation concomitant to other cardiovascular procedures and in the lone atrial fibrillation treatment utilizing a two port thoracoscopic approach.
