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Mini-invasive surgical ablation as an alternative for treating atrial fibrillation recurrence after catheter ablation
Session:
Comunicações Orais - Sessão 11 - Ablação de fibrilhação auricular
Speaker:
Margarida G. Figueiredo
Congress:
CPC 2024
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.4 Atrial Fibrillation - Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Margarida G. Figueiredo; Rui Cerejo; Sofia B. Paula; Carolina Rodrigues; Manuela Silva; Guilherme Portugal; Pedro Cunha; Hélder Santos; Rui Rodrigues; Mário Oliveira; Pedro Coelho
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Calibri","sans-serif"">Atrial fibrillation (AF) is the most common clinical arrhythmia, with a currently estimated prevalence of AF in adults between 2% and 4%, and a significant rate of recurrence after conventional AF catheter ablation. Minimally invasive cardiac surgery techniques have emerged to treat selected symptomatic patients (P) with AF refractory to pharmacological and percutaneous ablation. We aim to understand the safety and long-term efficacy of minimally invasive surgical AF ablation in P with AF recurrence after catheter ablation, without concomitant cardiac disease. Methods: Single-centre retrospective analysis of a cohort of P undergoing solely surgical ablation of AF with a video thoracoscopic (VATS) approach after two unsuccessful AF percutaneous ablations. Safety, intra-hospital complications and length of hospital stay were analysed. Regarding the efficacy of the procedure, patient’s rhythm was assessed (ECG, Holter or external loop recorder) in the immediate postoperative period, at discharge, at 1, 6 and 12 months, and in the long-term (beyond 12 months). Results: We studied 20 P (58.2±10.6 years; 47.4% female). Mean time since the diagnosis of AF was 6.9±3.8 years, 63.2% had paroxysmal AF, while 36.8% were diagnosed with persistent AF. All of them had been submitted to prior catheter ablation (mean of 2 attempts). Mean left ventricular ejection fraction (LVEF) by echocardiogram was 55±7.0% (16% with mildly-reduced LVEF). Mean volume of the left atrium (LA) was 36.3±10.6ml/m<sup>2</sup>, with 58% of the P presenting LA enlargement (16% mild, 37% moderate and 5% severe enlargement). The mean volume of the right atrium (RA) was 29.3±9.5ml/m<sup>2</sup>, with RA enlargement in 26.3% of the cases. Mean systolic pulmonary artery pressure was 29.8±6.4mmHg (10.5% presenting pulmonary hypertension). Mean hospital stay was 4.7±4.1 days. There were no cases of stroke or mortality during hospitalization; however, one P needed reintervention due to a hemothorax and other one needed permanent pacemaker implantation to treat tachy-brady syndrome. During hospitalization, 17 P (85%) remained in sinus rhythm (SR), while 2 P (10%) presented AF and one (5%) developed atrial flutter. All P were discharged in SR. Mean follow-up was 2.6±1.7 years, with 89.5%, 78.9%, and 73.7% of the P in SR at 1, 6 and 12 months, respectively. In the long-term follow-up (>12 months), 15 P (75%) remained in SR. Two (10%) cases had AF recurrence and 3 (15%) developed atypical atrial flutter (figure 1). One P died in the long-term follow-up, not related to cardiovascular disease. Age, duration of AF before the procedure, type of AF, LVEF, LA/RA enlargement and pulmonary hypertension were not predictors of AF recurrence after surgical ablation. Conclusions: In P with AF recurrence after multiple percutaneous catheter ablation attempts, minimally invasive surgical approach seems to represent a real benefit in the long term.</span></span></p>
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