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Immediate electrophysiological characteristics following modified thoracoscopic ablation via unilateral approach for non-valvular atrial fibrillation

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Abstract

Background

Thoracoscopic ablation has emerged as an effective therapy for patients with long-standing persistent Atrial fibrillation (LsPAF). We aimed to investigate the immediate electrophysiological characteristics following modified ablation with 3 circular and 3 linear lesions in the thoracoscopic procedure via a unilateral approach.

Methods

Between May 2015 and October 2018, 40 patients underwent the one-stage hybrid procedure for LsPAF. Isolation of the pulmonary veins (PV) and left atrium posterior wall (LAPW), excision of the left atrial appendage (LAA), and high-density endocardial mapping and individualized percutaneous catheter ablation for AF termination were performed.

Results

The modified thoracoscopic procedure may enable successful PV and LAPW isolation and LAA removal. Endocardial electrophysiological examination showed 6 out of 40 (15%) patients with a right PV gap, 3 (7.5%) patients with incomplete roof lesions, and 8 (20%) patients with incomplete Dallas lesions. A total of 44 driving areas were mapped and ablated. Thirty-five patients achieved procedural AF termination. After a mean follow-up period of 26 months, the success rate of a single procedure was 85%. Cox regression analysis demonstrated that the failure of procedural AF termination may be a risk factor in atrial tachyarrhythmia recurrence.

Discussion

Endocardial electrophysiological examination is a necessary partner to thoracoscopic ablation. Our modified thoracoscopic ablation and driving areas-based ablation contribute to high rates of procedural AF termination, which may lead to reduced recurrence rate. The hybrid procedure may be an effective strategy for the management of LsPAF.

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Acknowledgements

We would like to thank Kaicheng Song M.D., Baosheng Lv M.D., Liying Bai M.D.,Ms Fengnan Wang and Ms Chenyu Wu for their excellent support.

Funding

The work was sponsored by National Natural Science Foundation of China (Grant No. 81974023), Science and Technology Commission of Shanghai Municipality Grant (Grant Nos: 19411963800; 20Y11910700).

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Author notes

  1. Nan Ma, Shiao Ding and Lijun Zeng contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiothoracic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, 1665, Kongjiang Road, Yangpu District, Shanghai, 200092, China

    Nan Ma, Shiao Ding & Ju Mei

  2. Heart Center, Beijing Chao-Yang Hospital, Capital Medical University, 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, China

    Lijun Zeng & Xingpeng Liu

  3. Second Department of Cardiology, Hebei Yanda Hospital, Langfang City, Hebei, China

    Chen Tan & Shengchao Li

Authors
  1. Nan Ma
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  2. Shiao Ding
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  3. Lijun Zeng
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  4. Chen Tan
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  6. Xingpeng Liu
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  7. Ju Mei
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Correspondence to Xingpeng Liu or Ju Mei.

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Ma, N., Ding, S., Zeng, L. et al. Immediate electrophysiological characteristics following modified thoracoscopic ablation via unilateral approach for non-valvular atrial fibrillation. Heart Vessels 36, 874–881 (2021). https://doi.org/10.1007/s00380-020-01760-4

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  • DOI: https://doi.org/10.1007/s00380-020-01760-4

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