Thoracoscopy-assisted radiofrequency ablation and/or left atrial appendage exclusion for atrial fibrillation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 YAO Qing , YANG Yu , LIU Fei , MA Hao , XU Dong

Department of Cardiac and Vascular Surgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, P. R. China;

Corresponding author：

YAO Qing, Email: 1983yaoqing@163.com

Keywords：

Radiofrequency ablation for atrial fibrillation; left atrial appendage exclusion; thoracoscopy-assisted surgery

DOI：

10.7507/1007-4848.202008055

Video：

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Objective To investigate the short-term efficacy and safety of thoracoscopy-assisted epicardial radiofrequency ablation for atrial fibrillation (AF) and/or left atrial appendage exclusion (LAAE).Methods The clinical data of 12 patients with solitary AF admitted to Beijing Tiantan Hospital from November 2018 to August 2020 were retrospectively analyzed, including 7 males and 5 females, with an average age of 65.2±5.3 years. Of them, 2 had paroxysmal AF, 1 had persistent AF and 9 had permanent AF.Results No patient died during hospitalization, 5 patients underwent radiofrequency ablation for AF and LAAE, and 6 received LAAE alone. The operation time was 293±70 min in radiofrequency ablation for AF+LAAE patients and 71±14 min in LAAE patients. Two patients restored sinus rhythm, two restored after electric cardioversion, and one remained AF in AF+LAAE patients. Postoperatively, 1 patient had pleural effusion and 1 had subcutaneous emphysema. No stroke was observed.Conclusion Thoracoscopy-assisted radiofrequency ablation for AF and/or LAAE reduce the risk of procedure, and provide alternative approach to treat AF-associated diseases. However, large sample size studies using prospective cohort designs are required to corroborate the present findings.

Citation： YAO Qing, YANG Yu, LIU Fei, MA Hao, XU Dong. Thoracoscopy-assisted radiofrequency ablation and/or left atrial appendage exclusion for atrial fibrillation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(3): 330-334. doi: 10.7507/1007-4848.202008055 Copy

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11.	马南, 姜兆磊, 梅举,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.
12.	Caliskan E, Eberhard M, Falk V, et al. Incidence and characteristics of left atrial appendage stumps after device-enabled epicardial closure. Interact Cardiovasc Thorac Surg, 2019, 29(5): 663-669.
13.	Greenberg JW, Lee R, Hui DS. Patient selection and methods of surgical left atrial appendage exclusion. J Thromb Thrombolysis, 2019, 48(2): 209-214.
14.	Kareem B, Susan W, Edward K, et al. Left atrial appendage epicardial clip (AtriClip): Essentials and post-procedure management. J Atr Fibrillation, 2019, 11(6): 2087.
15.	Toale C, Fitzmaurice GJ, Eaton D, et al. Outcomes of left atrial appendage occlusion using the AtriClip device: A systematic review. Interact Cardiovasc Thorac Surg, 2019, 29(5): 655-662.
16.	Branzoli S, Marini M, Guarracini F, et al. Epicardial standalone left atrial appendage clipping for prevention of ischemic stroke in patients with atrial fibrillation contraindicated for oral anticaogulation. J Cardiovasc Electrophysiol, 2020, 31(8): 2187-2191.
17.	Turagam MK, Vuddanda V, Verberkmoes N, et al. Epicardial left atrial appendage exclusion reduces blood pressure in patients with atrial fibrillation and hypertension. J Am Coll Cardiol, 2018, 72(12): 1346-1353.

1. 马长生. 房颤的流行病学进展. 医学与哲学, 2016, 37(11B): 8-10.
2. 金勇, 许南燕, 罗伟良. 持续性房颤与阵发性房颤患者出现急性缺血性脑卒中的临床风险. 岭南急诊医学杂志, 2017, 22(4): 381-382.
3. 金晶. 利伐沙班与华法林对缺血性脑卒中合并非瓣膜性房颤病人抗凝治疗的疗效及安全性比较. 实用老年医学, 2019, 33(10): 1019-1021.
4. Ramlawi B, Bedeir K, Edgerton JR. Totally thoracoscopic closure of the left atrial appendage. Ann Thorac Surg, 2019, 107(1): e71-e73.
5. Johnkoski J, Miles B, Sudbury A, et al. Safety and long-term efficacy of thoracoscopic epicardial ablation in patients with paroxysmal atrial fibrillation: A retrospective study. J Cardiothorac Surg, 2019, 14(1): 188.
6. Cox JL, Churyla A, Malaisrie SC, et al. When is a Maze procedure a Maze procedure? Can J Cardiol, 2018, 34(11): 1482-1491.
7. Ruaengsri C, Schill MR, Khiabani AJ, et al. The Cox-maze Ⅳ procedure in its second decade: Still the gold standard? Eur J Cardiothorac Surg, 2018, 53(suppl_1): I19-I25.
8. Wolf RK. Treatment of lone atrial fibrillation: Minimally invasive pulmonary vein isolation, partial cardiac denervation and excision of the left atrial appendage. Ann Cardiothorac Surg, 2014, 3(1): 98-104.
9. van Laar C, Verberkmoes NJ, van Es HW, et al. Thoracoscopic left atrial appendage clipping: A multicenter cohort analysis. JACC Clin Electrophysiol, 2018, 4(7): 893-901.
10. Wolf RK, Schneeberger EW, Osterday R, et al. Video-assisted bilateral pulmonary vein isolation and left atrial appendage exclusion for atrial fibrillation. J Thorac Cardiovasc Surg, 2005, 130(3): 797-802.
11. 马南, 姜兆磊, 梅举,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.
12. Caliskan E, Eberhard M, Falk V, et al. Incidence and characteristics of left atrial appendage stumps after device-enabled epicardial closure. Interact Cardiovasc Thorac Surg, 2019, 29(5): 663-669.
13. Greenberg JW, Lee R, Hui DS. Patient selection and methods of surgical left atrial appendage exclusion. J Thromb Thrombolysis, 2019, 48(2): 209-214.
14. Kareem B, Susan W, Edward K, et al. Left atrial appendage epicardial clip (AtriClip): Essentials and post-procedure management. J Atr Fibrillation, 2019, 11(6): 2087.
15. Toale C, Fitzmaurice GJ, Eaton D, et al. Outcomes of left atrial appendage occlusion using the AtriClip device: A systematic review. Interact Cardiovasc Thorac Surg, 2019, 29(5): 655-662.
16. Branzoli S, Marini M, Guarracini F, et al. Epicardial standalone left atrial appendage clipping for prevention of ischemic stroke in patients with atrial fibrillation contraindicated for oral anticaogulation. J Cardiovasc Electrophysiol, 2020, 31(8): 2187-2191.
17. Turagam MK, Vuddanda V, Verberkmoes N, et al. Epicardial left atrial appendage exclusion reduces blood pressure in patients with atrial fibrillation and hypertension. J Am Coll Cardiol, 2018, 72(12): 1346-1353.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Thoracoscopy-assisted radiofrequency ablation and/or left atrial appendage exclusion for atrial fibrillation

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