JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
As to the coronary sinus, there is the clear presence of histo- anatomic connections linking the inferior right atrium to the left atrial myocardium via a cuff of striated muscle around the coronary sinus in humans. 28 Overall, the presence of these variable muscular connections indicates a consistent pathway for interatrial propagation and possibly further reentrant flutters if not addressed. We feel we addressed this potential short- fall by incorporating a CS os lesion set into the cavotricuspid isthmus line. It was also noted that overall procedure time was able to be reduced with adoption of the herein-described hybrid approach. This decrease in procedure time was noted in both the endocardial as well as the epicardial portions of the procedure. The strengths of this study are that it represents a single-center studywherethelesion-applicationstrategywasuniformamongst all patients. It also shows an excellent one year arrhythmia-free survival even when accounting for the continuous monitoring strategy, the inclusion of very dilated left atria and the exclusion of patients with paroxysmal atrial fibrillation.
updated review. Europace. 2013;15:170-82.
8. Kron J, Kasirajan V, Wood MA, Kowalski M, Han FT, Ellenbogen KA. Management of recurrent atrial arrhythmias after minimally invasive surgical pulmonary vein isolation and ganglionic plexi ablation for atrial fibrillation. Heart Rhythm . 2010;7:445-51. 9. Abo-Salem E, Paone RF, Nugent K, Perez-Verdia A, Deshpande A, Amiri HM. Stand alone surgical ablation for atrial fibrillation. J Card Surg. 2013;28:315- 20. 10. Pison L, LAMM, vanOJ, BlaauwY, Maessen J, Crijns HJ. Hybrid thoracoscopic surgical and transvenous catheter ablation of atrial fibrillation. J Am Coll Cardiol. 2012;60:54-61. 11. Pison L, Gelsomino S, Luca F, Parise O, Maessen JG, Crijns HJ, LA MM. Effectiveness and safety of simultaneous hybrid thoracoscopic and endocardial catheter ablation of lone atrial fibrillation. Ann Cardiothorac Surg. 2014;3:38-44. 12. Gersak B, Zembala MO, Muller D, Folliguet T, Jan M, Kowalski O, Erler S, Bars C, Robic B, Filipiak K, Wimmer-Greinecker G. European experience of the convergent atrial fibrillation procedure: multicenter outcomes in consecutive patients. J Thorac Cardiovasc Surg. 2014;147:1411-6. 13. Krul SP, Pison L, La MM, Driessen AH, Wilde AA, Maessen JG, De Mol BA, Crijns HJ, de Groot JR. Epicardial and endocardial electrophysiological guided thoracoscopic surgery for atrial fibrillation: a multidisciplinary approach of atrial fibrillation ablation in challenging patients. I nt J Cardiol. 2014;173:229-35. 14. CammAJ, Lip GY, De Caterina R, Savelieva I, Atar D, Hohnloser SH, Hindricks G, Kirchhof P, ESC Committee for Practice Guidelines (CPG). 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J . 2012;33:2719-47. 15. CammAJ, Lip GY, De Caterina R, Savelieva I, Atar D, Hohnloser SH, Hindricks G, Kirchhof P, Bax JJ, Baumgartner H. ESC Committee for Practice Guidelines; document reviewers: 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC guidelines for the management of atrial fibrillationGcodeveloped with the special contribution of the European Heart Rhythm Association. Europace. 2012;14:1385-413. 16. Oral H, Knight BP, Ozaydin M, Tada H, Chugh A, Hassan S, Scharf C, Lai SW, Greenstein R, Pelosi F, Jr., Strickberger SA, Morady F. Clinical significance of early recurrences of atrial fibrillation after pulmonary vein isolation. J Am Coll Cardiol. 2002;40:100-4. 17. Calkins H, Kuck KH, Cappato R, Brugada J, Camm AJ, Chen SA, Crijns HJ, Damiano RJ, Jr., Davies DW, DiMarco J, Edgerton J, Ellenbogen K, Ezekowitz MD, Haines DE, Haissaguerre M, Hindricks G, Iesaka Y, Jackman W, Jalife J, Jais P, Kalman J, Keane D, Kim YH, Kirchhof P, Klein G et al. 2012 HRS/EHRA/ ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design. Europace . 2012;14:528-606. 18. Allessie M, Ausma J, Schotten U. Electrical, contractile and structural remodeling during atrial fibrillation. Cardiovasc Res. 2002;54:230-46. 19. Lin WS, Tai CT, Hsieh MH, Tsai CF, Lin YK, Tsao HM, Huang JL, Yu WC, Yang SP, Ding YA, Chang MS, Chen SA. Catheter ablation of paroxysmal atrial fibrillation initiated by non-pulmonary vein ectopy. Circulation. 2003;107:3176-83. 20. Chen SA, Tai CT, Yu WC, Chen YJ, Tsai CF, Hsieh MH, Chen CC, Prakash VS, Ding YA, Chang MS. Right atrial focal atrial fibrillation: electrophysiologic characteristics and radiofrequency catheter ablation. J Cardiovasc Electrophysiol. 1999;10:328-35. 21. Kalifa J, Tanaka K, Zaitsev AV, Warren M, Vaidyanathan R, Auerbach D, Pandit S, Vikstrom KL, Ploutz-Snyder R, Talkachou A, Atienza F, Guiraudon G, Jalife J, Berenfeld O. Mechanisms of wave fractionation at boundaries of high-frequency excitation in the posterior left atrium of the isolated sheep heart during atrial fibrillation. Circulation. 2006;113:626-33. 22. Gersak B, Pernat A, Robic B, Sinkovec M. Low rate of atrial fibrillation recurrence verified by implantable loop recorder monitoring following a convergent epicardial and endocardial ablation of atrial fibrillation. J Cardiovasc Electrophysiol. 2012;23:1059-66. 23. Zembala MO, Suwalski P. Minimally invasive surgery for atrial fibrillation. J Thorac Dis. 2013;5 Suppl 6:S704-S712. 24. Patterson E, Po SS, Scherlag BJ, Lazzara R. Triggered firing in pulmonary veins initiated by in vitro autonomic nerve stimulation. Heart Rhythm. 2005;2:624-31.
CONCLUSION
We describe promising results at 12 months in PeAF and LPeAF patients using a hybrid approach wherein the endovascular lesions are applied prior the epicardial compared to the traditional approach of epicardial lesions first compared to previously described reports and with higher success rates than in these same reports. All recurrent arrhythmiaswereparoxysmal in nature and required no intervention for management. Although clearly establishing the superiority of this approach would require a randomized trial, we believe it shows enough promise to warrant further investigation and longer-term data.
REFERENCES
1. Lloyd-Jones DM, Wang TJ, Leip EP, Larson MG, Levy D, Vasan RS, D’Agostino RB, Massaro JM, Beiser A, Wolf PA, Benjamin EJ. Lifetime risk for development of atrial fibrillation: the Framingham Heart Study. Circulation 2004;110:1042-6. 2. Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, Selby JV, Singer DE. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA 2001;285:2370-5. 3. Naccarelli GV, Varker H, Lin J, Schulman KL. Increasing prevalence of atrial fibrillation and flutter in the United States. Am J Cardiol. 2009;104:1534-9. 4. Ganesan AN, Shipp NJ, Brooks AG, Kuklik P, Lau DH, Lim HS, Sullivan T, Roberts-Thomson KC, Sanders P. Long-term outcomes of catheter ablation of atrial fibrillation: a systematic review and meta-analysis. J Am Heart Assoc . 2013;2:e004549. 5. Weerasooriya R, Khairy P, Litalien J, Macle L, Hocini M, Sacher F, Lellouche N, Knecht S, Wright M, Nault I, Miyazaki S, Scavee C, Clementy J, Haissaguerre M, Jais P. Catheter ablation for atrial fibrillation: are results maintained at 5 years of follow-up? J Am Coll Cardiol. 2011;57:160-6. 6. Chao TF, Tsao HM, Lin YJ, Tsai CF, Lin WS, Chang SL, Lo LW, Hu YF, Tuan TC, Suenari K, Li CH, Hartono B, Chang HY, Ambrose K, Wu TJ, Chen SA. Clinical outcome of catheter ablation in patients with nonparoxysmal atrial fibrillation: results of 3-year follow-up. Circ Arrhythm Electrophysiol. 2012;5:514-20. 7. La MM, Gelsomino S, Luca F, Pison L, Colella A, Lorusso R, Crudeli E, Gensini GF, Crijns HG, Maessen J. Minimal invasive surgery for atrial fibrillation: an
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