PMID- 28760469
OWN - NLM
STAT- MEDLINE
DCOM- 20171204
LR  - 20171204
IS  - 1552-6259 (Electronic)
IS  - 0003-4975 (Linking)
VI  - 104
IP  - 6
DP  - 2017 Dec
TI  - Delayed Electroanatomic Mapping After Surgical Ablation for Persistent Atrial
      Fibrillation.
PG  - 2024-2029
LID - S0003-4975(17)30693-8 [pii]
LID - 10.1016/j.athoracsur.2017.05.018 [doi]
AB  - BACKGROUND: Long-term efficacy of catheter-based treatment of persistent atrial
      fibrillation is unsatisfactory. Minimally invasive surgical ablation techniques
      have been developed recently but their true efficacy has never been
      systematically tested. METHODS: Seventy patients (median age 63.5 years) with
      persistent atrial fibrillation underwent epicardial thoracoscopic radiofrequency 
      pulmonary vein (PV) isolation, linear ablation, Marshal ligament disruption, and 
      exclusion of the left atrial appendage. The procedure was followed by
      electroanatomic mapping 2 to 3 months later. RESULTS: Only 76% of patients were
      in sinus rhythm at the beginning of electroanatomic mapping. Right PVs were found
      isolated in a higher proportion of patients compared with left PVs (75.7% versus 
      91.4%, p < 0.001). All four PVs and the left atrial posterior wall were isolated 
      in 68.6% and 22.9% of patients, respectively. Most of the gaps around left PVs
      were localized in the superior and anterior quadrants, whereas in right PVs, the 
      gaps were found predominantly on the roof and posterior wall. A typical site of
      reconduction on the inferior connecting line was the segment adjacent to the
      right inferior PV. No typical reconduction sites were found on the roof line, as 
      58.5% of patients required completion of the roof line along its full length.
      CONCLUSIONS: Epicardial PV isolation was successful in the majority of patients, 
      but was underwhelming with regard to isolation of the left PVs. Effective
      epicardially placed linear lines were rare. Our results highlight the significant
      limitations associated with a single-stage surgical approach and underline the
      necessity for a two-staged hybrid approach in the treatment of persistent atrial 
      fibrillation.
CI  - Copyright (c) 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc.
      All rights reserved.
FAU - Bulava, Alan
AU  - Bulava A
AD  - Department 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. Electronic address: alanbulava@seznam.cz.
FAU - Mokracek, Ales
AU  - Mokracek A
AD  - Department of Cardiac Surgery, Budweis Hospital, Ceske Budejovice, Czech
      Republic; Faculty of Health and Social Sciences, University of South Bohemia,
      Ceske Budejovice, Czech Republic.
FAU - Kurfirst, Vojtech
AU  - Kurfirst V
AD  - Department of Cardiac Surgery, Budweis Hospital, Ceske Budejovice, Czech
      Republic.
LA  - eng
PT  - Journal Article
DEP - 20170729
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
SB  - AIM
SB  - IM
MH  - Adult
MH  - Aged
MH  - Atrial Fibrillation/*diagnosis/physiopathology/surgery
MH  - Catheter Ablation/*methods
MH  - Electrophysiologic Techniques, Cardiac/*methods
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Minimally Invasive Surgical Procedures/*methods
MH  - Time Factors
MH  - Treatment Outcome
EDAT- 2017/08/02 06:00
MHDA- 2017/12/05 06:00
CRDT- 2017/08/02 06:00
PHST- 2017/02/06 00:00 [received]
PHST- 2017/04/07 00:00 [revised]
PHST- 2017/05/05 00:00 [accepted]
PHST- 2017/08/02 06:00 [pubmed]
PHST- 2017/12/05 06:00 [medline]
PHST- 2017/08/02 06:00 [entrez]
AID - S0003-4975(17)30693-8 [pii]
AID - 10.1016/j.athoracsur.2017.05.018 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2017 Dec;104(6):2024-2029. doi:
      10.1016/j.athoracsur.2017.05.018. Epub 2017 Jul 29.