Anesthesia Management for Complete Thoracoscopic Surgical Atrial Fibrillation Ablation via the Left Chest_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JIANGZhao-lei ¹ , MEIJu ¹ , MANan ¹ , YINHang ¹ , LIUHao ¹ , HEYi ¹ , DINGFang-bao ¹ ,  SHENSai-e ²

1. Department of Cardiothoracic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200092, P. R. China;
2. Department of Anesthesiology, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200092, P. R. China;

Corresponding author：

SHENSai-e, Email: ej8710@sina.com

Keywords：

Atrial fibrillation; Minimally invasive surgery; Radiofrequency ablation; Anesthesia management

DOI：

10.7507/1007-4848.20160027

Video：

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Objective To discuss the intraoperative anesthesia management for complete thoracoscopic surgical atrial fibrillation (AF) ablation via the left chest. Methods We retrospectively analyzed the clinical data of 201 patients (106 males and 95 females aged 58.7±15.4 years) with AF underwent complete thoracoscopic surgical ablation via the left chest in Department of Cardiothoracic surgery, Xinhua Hospital From September 2010 through December 2013. Results All the patients successfully underwent the minimally invasive ablation procedure. No patient required conversion to sternotomy during the surgery. The average time of operation was 104.9±37.2 min. During the ablation procedure, the patients' blood pressure and arterial oxygen saturation (SpO₂) reduced at different levels. The average minimum arterial blood pressure was 44-79 (62.4±8.4) mm Hg. The average minimum SpO₂ was 83%-95% (88.8%±3.1%). After the ablation, the patients' respiratory function and hemodynamic gradually recovered. The average heart rate was 40-108 (70.0±16.6) bpm when sinus rhythm was restored. The maintenance of sinus rhythm rate was 94.5% (190/201) at discharge. There was no early death, stroke, hemorrhage or permanent pacemaker implantation during perioperation. Conclusion Complete thoracoscopic surgical AF ablation via the left chest has some influence on patients' respiratory function and hemodynamic. Reasonable anesthetic management can ensure the minimally invasive ablation procedure safe and effective.

Citation： JIANGZhao-lei, MEIJu, MANan, YINHang, LIUHao, HEYi, DINGFang-bao, SHENSai-e. Anesthesia Management for Complete Thoracoscopic Surgical Atrial Fibrillation Ablation via the Left Chest. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2016, 23(2): 119-123. doi: 10.7507/1007-4848.20160027 Copy

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2.	Healey JS, Connolly SJ, Gold MR, et al. ASSERT Investigators. Subclinical atrial fibrillation and the risk of stroke. N Engl J Med, 2012, 366(2): 120-129.
3.	Chugh SS, Havmoeller R, Narayanan K, et al. Worldwide epidemio-logy of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation, 2014, 129(8): 837-847.
4.	Cox JL, Schuessler RB, D'Agostino HJ Jr, et al. The surgical treatment of atrial fibrillation. Ⅲ. Development of a definitive surgical proce-dure. J Thorac Cardiovasc Surg, 1999, 101(4): 569-583.
5.	Weimar T, Schena S, Bailey MS, et al. The cox-maze procedure for lone atrial fibrillation: a single-center experience over 2 decades. Circ Arrhythm Electrophysiol. 2012, 5(1):8-14.
6.	Prasad SM, Maniar HS, Camillo CJ, et al. The Cox Maze Ⅲ proce-dure for atrial fibrillation: long-term efficacy in patients undergoing lone versus concomitant procedures. J Thorac Cardiovasc Surg, 2003, 126(6): 1822-1828.
7.	Mei J, Ma N, Ding F, et al. Complete thoracoscopic ablation of the left atrium via the left chest for treatment of lone atrial fibrillation. J Thorac Cardiovasc Surg, 2014, 147(1): 242-246.
8.	Ma N, Ding F, Jiang Z, et al. Totally endoscopic ablation of left atrium via left chest for lone atrial fibrillation. Innovations (Phila), 2012, 7(5): 382-384.
9.	马南, 丁芳宝, 陈寅, 等. 左胸径路微创外科治疗孤立性心房颤动. 中华胸心血管外科杂志, 2013, 29(11): 692-693.
10.	马南, 姜兆磊, 陈飞, 等. 梅氏微创消融术治疗心房颤动207例. 中国胸心血管外科临床杂志, 2015, 22(11): 996-999.
11.	Wolf RK, Schneeberger EW, Osterday R, et al. Video-assisted bila-teral pulmonary vein isolation and left atrial appendage exclusion for atrial fibrillation. J Thorac Cardiovasc Surg, 2005, 130(3): 797-802.
12.	Jung SM, Cho CK, Kim YJ, et al. The effect of thoracic epidural anesthesia on pulmonary shunt fraction and arterial oxygenation during one-lung ventilation. J Cardiothorac Vasc Anesth, 2010, 24(3): 456-462.
13.	Ishikawa S, Lohser J. One-lung ventilation and arterial oxygenation. Curr Opin Anaesthesiol, 2011, 24(1): 24-31.
14.	Karzai W, Schwarzkopf K. Hypoxemia during one-lung ventilation: prediction, prevention, and treatment. Anesthesiology, 2009, 110(6): 1402-1411.
15.	Dunn PF. Physiology of the lateral decubitus position and one-lung ventilation. Int Anesthesiol Clin, 2000, 38(1): 25-53.
16.	Joo J, Kim YH, Lee J, et al. Difference in the value of arterial and end-tidal carbon dioxide tension according to different surgical positions: Does it reliably reflect ventilation-perfusion mismatch? Korean J Anesthesiol, 2012, 63(3): 216-220.
17.	Klein U, Karzai W, Bloos F, et al. Role of fiberoptic bronchoscopy in conjunction with the use of double-lumen tubes for thoracic anesthesia: a prospective study. Anesthesiology, 1998, 88(2): 346-350.
18.	Slinger PD. Fiberoptic bronchoscopic positioning of double-lumen tubes. J Cardiothorac Anesth, 1989, 3(4): 486-496.
19.	Leite CF, Calixto MC, Toro IF, et al. Characterization of pulmonary and systemic inflammatory responses produced by lung re-expan-sion after one-lung ventilation. J Cardiothorac Vasc Anesth, 2012, 26(3): 427-432.
20.	Sugiyama Y, Shimizu F, Shimizu S, et al. Severe Re-expansion Pulmonary Edema Induced by One-Lung Ventilation. Respir Care, 2015 Feb 17. pii: respcare.03759.[Epub ahead of print].
21.	Hedenstierna G. Pulmonary perfusion during anesthesia and mechanical ventilation. Minerva Anestesiol, 2005, 71(6): 319-324.
22.	Monfredi O, Boyett MR. Sick sinus syndrome and atrial fibrillation in older persons-A view from the sinoatrial nodal myocyte. J Mol Cell Cardiol, 2015 Feb 7. pii: S0022-2828(15)00040-1. doi: 10.1016/j.yjmcc.2015.02.003.[Epub ahead of print].
23.	Amasyali B, Kilic A, Kilit C. Sinus node dysfunction and atrial fibrillation: which one dominates?. Int J Cardiol, 2014, 175: 379-380.
24.	Wilber DJ. Fibroblasts, focal triggers, and persistent atrial fibrilla-tion: is there a connection? Circ Arrhythm Electrophysiol, 2012, 5(2): 249-251.
25.	Inoue K, Kurotobi T, Kimura R, et al. Trigger-based mechanism of the persistence of atrial fibrillation and its impact on the efficacy of catheter ablation. Circ Arrhythm Electrophysiol, 2012, 5(2): 295-301.
26.	Kim YH. Catheter ablation of longstanding persistent atrial fibrillation. Are we on the right path? Circ J, 2012, 76(6): 1299-1306.
27.	Jarman JW, Wong T, Kojodjojo P, et al. Organizational index mapping to identify focal sources during persistent atrial fibrillation. J Cardiovasc Electrophysiol, 2014, 25(4): 355-363.
28.	姜兆磊, 朱家全, 梅举, 等. 腔静脉内阻断技术在单纯性三尖瓣微创手术中的应用. 中国心血管病研究, 2013, 11(8): 564-567.

1. McCabe PJ, DeVon HA. Home-based management of patients with atrial fibrillation. Lancet, 2015, 385(9970): 752-753.
2. Healey JS, Connolly SJ, Gold MR, et al. ASSERT Investigators. Subclinical atrial fibrillation and the risk of stroke. N Engl J Med, 2012, 366(2): 120-129.
3. Chugh SS, Havmoeller R, Narayanan K, et al. Worldwide epidemio-logy of atrial fibrillation: a Global Burden of Disease 2010 Study. Circulation, 2014, 129(8): 837-847.
4. Cox JL, Schuessler RB, D'Agostino HJ Jr, et al. The surgical treatment of atrial fibrillation. Ⅲ. Development of a definitive surgical proce-dure. J Thorac Cardiovasc Surg, 1999, 101(4): 569-583.
5. Weimar T, Schena S, Bailey MS, et al. The cox-maze procedure for lone atrial fibrillation: a single-center experience over 2 decades. Circ Arrhythm Electrophysiol. 2012, 5(1):8-14.
6. Prasad SM, Maniar HS, Camillo CJ, et al. The Cox Maze Ⅲ proce-dure for atrial fibrillation: long-term efficacy in patients undergoing lone versus concomitant procedures. J Thorac Cardiovasc Surg, 2003, 126(6): 1822-1828.
7. Mei J, Ma N, Ding F, et al. Complete thoracoscopic ablation of the left atrium via the left chest for treatment of lone atrial fibrillation. J Thorac Cardiovasc Surg, 2014, 147(1): 242-246.
8. Ma N, Ding F, Jiang Z, et al. Totally endoscopic ablation of left atrium via left chest for lone atrial fibrillation. Innovations (Phila), 2012, 7(5): 382-384.
9. 马南, 丁芳宝, 陈寅, 等. 左胸径路微创外科治疗孤立性心房颤动. 中华胸心血管外科杂志, 2013, 29(11): 692-693.
10. 马南, 姜兆磊, 陈飞, 等. 梅氏微创消融术治疗心房颤动207例. 中国胸心血管外科临床杂志, 2015, 22(11): 996-999.
11. Wolf RK, Schneeberger EW, Osterday R, et al. Video-assisted bila-teral pulmonary vein isolation and left atrial appendage exclusion for atrial fibrillation. J Thorac Cardiovasc Surg, 2005, 130(3): 797-802.
12. Jung SM, Cho CK, Kim YJ, et al. The effect of thoracic epidural anesthesia on pulmonary shunt fraction and arterial oxygenation during one-lung ventilation. J Cardiothorac Vasc Anesth, 2010, 24(3): 456-462.
13. Ishikawa S, Lohser J. One-lung ventilation and arterial oxygenation. Curr Opin Anaesthesiol, 2011, 24(1): 24-31.
14. Karzai W, Schwarzkopf K. Hypoxemia during one-lung ventilation: prediction, prevention, and treatment. Anesthesiology, 2009, 110(6): 1402-1411.
15. Dunn PF. Physiology of the lateral decubitus position and one-lung ventilation. Int Anesthesiol Clin, 2000, 38(1): 25-53.
16. Joo J, Kim YH, Lee J, et al. Difference in the value of arterial and end-tidal carbon dioxide tension according to different surgical positions: Does it reliably reflect ventilation-perfusion mismatch? Korean J Anesthesiol, 2012, 63(3): 216-220.
17. Klein U, Karzai W, Bloos F, et al. Role of fiberoptic bronchoscopy in conjunction with the use of double-lumen tubes for thoracic anesthesia: a prospective study. Anesthesiology, 1998, 88(2): 346-350.
18. Slinger PD. Fiberoptic bronchoscopic positioning of double-lumen tubes. J Cardiothorac Anesth, 1989, 3(4): 486-496.
19. Leite CF, Calixto MC, Toro IF, et al. Characterization of pulmonary and systemic inflammatory responses produced by lung re-expan-sion after one-lung ventilation. J Cardiothorac Vasc Anesth, 2012, 26(3): 427-432.
20. Sugiyama Y, Shimizu F, Shimizu S, et al. Severe Re-expansion Pulmonary Edema Induced by One-Lung Ventilation. Respir Care, 2015 Feb 17. pii: respcare.03759.[Epub ahead of print].
21. Hedenstierna G. Pulmonary perfusion during anesthesia and mechanical ventilation. Minerva Anestesiol, 2005, 71(6): 319-324.
22. Monfredi O, Boyett MR. Sick sinus syndrome and atrial fibrillation in older persons-A view from the sinoatrial nodal myocyte. J Mol Cell Cardiol, 2015 Feb 7. pii: S0022-2828(15)00040-1. doi: 10.1016/j.yjmcc.2015.02.003.[Epub ahead of print].
23. Amasyali B, Kilic A, Kilit C. Sinus node dysfunction and atrial fibrillation: which one dominates?. Int J Cardiol, 2014, 175: 379-380.
24. Wilber DJ. Fibroblasts, focal triggers, and persistent atrial fibrilla-tion: is there a connection? Circ Arrhythm Electrophysiol, 2012, 5(2): 249-251.
25. Inoue K, Kurotobi T, Kimura R, et al. Trigger-based mechanism of the persistence of atrial fibrillation and its impact on the efficacy of catheter ablation. Circ Arrhythm Electrophysiol, 2012, 5(2): 295-301.
26. Kim YH. Catheter ablation of longstanding persistent atrial fibrillation. Are we on the right path? Circ J, 2012, 76(6): 1299-1306.
27. Jarman JW, Wong T, Kojodjojo P, et al. Organizational index mapping to identify focal sources during persistent atrial fibrillation. J Cardiovasc Electrophysiol, 2014, 25(4): 355-363.
28. 姜兆磊, 朱家全, 梅举, 等. 腔静脉内阻断技术在单纯性三尖瓣微创手术中的应用. 中国心血管病研究, 2013, 11(8): 564-567.

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Anesthesia Management for Complete Thoracoscopic Surgical Atrial Fibrillation Ablation via the Left Chest

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