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Marek P. Ehrlich Guenther Laufer Iuliana Coti Markus Peter Martin Andreas Guenter Stix Niv Ad 《The Journal of thoracic and cardiovascular surgery》2019,157(1):248-256
Objective
The study objective was to study the electrophysiologic mechanism of atrial fibrillation using a noninvasive, beat-by-beat, 3-dimensional mapping technique in patients with persistent and long-standing persistent atrial fibrillation undergoing concomitant surgical ablation.Methods
In this pilot trial, 10 patients (6 male; mean age, 70 ± 10 years) with persistent atrial fibrillation were mapped preoperatively with a noninvasive surface system (ECVUE, CardioInsight, Medtronic Inc, Minneapolis, Minn). Eight patients were candidates for mitral valve surgery, 1 patient was a candidate for aortic valve and ascending aortic replacement, and 1 patient was a candidate for coronary bypass surgery. In 5 patients, tricuspid valve repair was also performed. The Cox-Maze III/IV was performed using combined cryoablation and bipolar radiofrequency, and the left appendage was removed in all cases. The median preprocedural duration of atrial fibrillation was 30 months, and the diameter of the left atrium was 63 mm. Atrial regions were divided according to the Bordeaux classification.Results
Preoperative mapping was successful in all patients with clear identification of the potential mechanism of atrial fibrillation. Biatrial pathology was recognized in all subjects. Rotor and macro re-entry activity were present in all patients, whereas focal activity was demonstrated in only 6 patients. Rotor activity in the right atrium was documented in all patients.Conclusions
This is the first report on the preoperative use of the ECUVE in surgical candidates for concomitant surgical procedures. The fact that a biatrial mechanism for atrial fibrillation was detected in all patients emphasizes the importance of a Cox-Maze III/IV procedure to treat patients with valvular heart disease and nonparoxysmal atrial fibrillation. Preoperative mapping has the potential to significantly improve our understanding of the pathophysiology in atrial fibrillation and better guide the surgical ablation procedure of choice in a single patient. 相似文献2.
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Impact of left atrial volume reduction concomitant with atrial fibrillation surgery on left atrial geometry and mechanical function 总被引：1，自引：0，他引：1
Marui A Saji Y Nishina T Tadamura E Kanao S Shimamoto T Sasahashi N Ikeda T Komeda M 《The Journal of thoracic and cardiovascular surgery》2008,135(6):1297-1305
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Eugene H. Blackstone Helena L. Chang Jeevanantham Rajeswaran Michael K. Parides Hemant Ishwaran Liang Li John Ehrlinger Annetine C. Gelijns Alan J. Moskowitz Michael Argenziano Joseph J. DeRose Jean-Phillipe Couderc Dan Balda François Dagenais Michael J. Mack Gorav Ailawadi Peter K. Smith Michael A. Acker Anne Schering 《The Journal of thoracic and cardiovascular surgery》2019,157(1):234-243.e9
Objective
To use novel statistical methods for analyzing the effect of lesion set on (long-standing) persistent atrial fibrillation (AF) in the Cardiothoracic Surgical Trials Network trial of surgical ablation during mitral valve surgery (MVS).Methods
Two hundred sixty such patients were randomized to MVS + surgical ablation or MVS alone. Ablation was randomized between pulmonary vein isolation and biatrial maze. During 12 months postsurgery, 228 patients (88%) submitted 7949 transtelephonic monitoring (TTM) recordings, analyzed for AF, atrial flutter (AFL), or atrial tachycardia (AT). As previously reported, more ablation than MVS-alone patients were free of AF or AF/AFL at 6 and 12 months (63% vs 29%; P < .001) by 72-hour Holter monitoring, without evident difference between lesion sets (for which the trial was underpowered).Results
Estimated freedom from AF/AFL/AT on any transmission trended higher after biatrial maze than pulmonary vein isolation (odds ratio, 2.31; 95% confidence interval, 0.95-5.65; P = .07) 3 to 12 months postsurgery; estimated AF/AFL/AT load (ie, proportion of TTM strips recording AF/AFL/AT) was similar (odds ratio, 0.90; 95% confidence interval, 0.57-1.43; P = .6). Within 12 months, estimated prevalence of AF/AFL/AT by TTM was 58% after MVS alone, and 36% versus 23% after pulmonary vein isolation versus biatrial maze (P < .02).Conclusions
Statistical modeling using TTM recordings after MVS in patients with (long-standing) persistent AF suggests that a biatrial maze is associated with lower AF/AFL/AT prevalence, but not a lower load, compared with pulmonary vein isolation. The discrepancy between AF/AFL/AT prevalence assessed at 2 time points by Holter monitoring versus weekly TTM suggests the need for a confirmatory trial, reassessment of definitions for failure after ablation, and validation of statistical methods for assessing atrial rhythms longitudinally. 相似文献14.
Atrial fibrillation is a common arrhythmia frequently seen in surgical patients. The onset of new atrial fibrillation during the peri-operative period is less common. There are many possible precipitating factors, although volatile agents themselves may have an antifibrillatory action. The management of atrial fibrillation includes removal of any precipitating factors and treatment of the arrhythmia itself. Immediate management of acute-onset atrial fibrillation is usually direct current cardioversion. Alternatively, anti-arrhythmic drugs can be used to achieve cardioversion. In patients with rapid, chronic atrial fibrillation or those refractory to cardioversion, priority is given to control of the ventricular rate. Thrombo-embolism is a significant risk if atrial fibrillation is paroxysmal or persists for more than 48 h. 相似文献
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目的 总结双侧腋下小切口直视下肺静脉隔离及左心耳切除治疗孤立性心房颤动的临床经验.方法 对28例孤立性心房颤动患者通过腋下小切口径路,直视下用Atricure双极射频消融系统行双侧肺静脉隔离及左心耳切除、Marshall韧带切断.结果 无围术期死亡、Ⅲ度房室传导阻滞、脑卒中及大出血等严重并发症,气管插管时间（4.2±2.6）h,平均住院时间（5.8±3.2）d.24例患者术毕转复窦性心律,1例电复律后转复,3例5d内转复.平均随访16.5个月,1例心房颤动复发,2例出现阵发性房性早搏.结论 双侧腋下小切口直视下射频消融治疗孤立性心房颤动效果良好,无需特殊器械辅助,易于推广. 相似文献
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Predictors of atrial fibrillation after off-pump coronary artery bypass graft surgery 总被引：1，自引：0，他引：1
Hosokawa K Nakajima Y Umenai T Ueno H Taniguchi S Matsukawa T Mizobe T 《British journal of anaesthesia》2007,98(5):575-580
Background: Postoperative atrial fibrillation (AF) is one of the most commoncomplications after cardiothoracic surgery and is associatedwith an increased risk of stroke, and longer hospital stay.The pathophysiology of postoperative AF is uncertain, and itsprevention remains unsatisfactory. Many previous studies haveexamined the predictors of AF after on-pump coronary arterybypass graft surgery (CABG), but there are few reports afteroff-pump CABG. Methods: The aim of the present prospective observational study, in which296 consecutive patients were enrolled, was to elucidate thepredictors of AF after off-pump CABG. The association of perioperativefactors with AF was investigated using univariate analysis.Significant variables were included into a stepwise logisticregression model to ascertain their independent influence onthe occurrence of AF. Results: The incidence of AF was 32%. AF prolonged the time until patientswere fit for discharge by 3 days (P < 0.01). Stepwise multivariateanalysis identified increasing age [odds ratio (OR) 1.44 per10-yr increase; 95% confidence interval (CI) 1.06–1.95],intraoperative average core temperature (OR 1.64; 95% CI 1.05–2.56),the average cardiac index in the intensive care unit (OR 0.37;95% CI 0.19–0.71), and intraoperative fluid balance (OR0.96 per 100-ml increase; 95% CI 0.93–0.99) as independentpredictors of postoperative AF. Conclusion: Our present findings indicate that ageing, the intraoperativefluid balance, and postoperative cardiac index are associatedwith the onset of AF after off-pump CABG. 相似文献
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