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Delayed Electroanatomic Mapping After Surgical Ablation for Persistent Atrial Fibrillation.

Alan Bulava1, Ales Mokracek2, Vojtech Kurfirst3

  • 1Department of Cardiology, Budweis Hospital, Ceske Budejovice, Czech Republic; Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic; Faculty of Health and Social Sciences, University of South Bohemia, Ceske Budejovice, Czech Republic.

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Summary

Minimally invasive surgical ablation for persistent atrial fibrillation showed limited success, particularly for left pulmonary veins. A two-stage hybrid approach may be necessary for better outcomes in treating this condition.

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Area of Science:

  • Cardiology
  • Thoracic Surgery
  • Electrophysiology

Background:

  • Catheter-based treatments for persistent atrial fibrillation have suboptimal long-term efficacy.
  • Minimally invasive surgical ablation offers an alternative but requires efficacy assessment.

Purpose of the Study:

  • To evaluate the efficacy of a single-stage epicardial thoracoscopic surgical ablation for persistent atrial fibrillation.

Main Methods:

  • Seventy patients with persistent atrial fibrillation underwent epicardial thoracoscopic radiofrequency pulmonary vein isolation, linear ablation, and left atrial appendage exclusion.
  • Electroanatomic mapping was performed 2-3 months post-procedure to assess ablation success.

Main Results:

  • Only 76% of patients were in sinus rhythm at follow-up mapping.
  • Pulmonary vein isolation was more successful for right than left veins.
  • Effective linear lesions were infrequently achieved, with frequent gaps and reconduction observed.

Conclusions:

  • Single-stage epicardial ablation has significant limitations for persistent atrial fibrillation, especially regarding left pulmonary vein isolation and linear lesion creation.
  • A two-stage hybrid approach is suggested to improve treatment effectiveness.