Thoracoscopic infrared ablation to create a box lesion as a treatment for atrial fibrillation.
Ablation
Atrial fibrillation
Box lesion
Epicardial ablation
Epicardial maze procedure
Ex-maze procedure
Infrared
Infrared coagulator
Left atrial appendage amputation
Thoracoscopic surgery
Journal
Journal of cardiothoracic surgery
ISSN: 1749-8090
Titre abrégé: J Cardiothorac Surg
Pays: England
ID NLM: 101265113
Informations de publication
Date de publication:
08 Jan 2022
08 Jan 2022
Historique:
received:
18
01
2021
accepted:
29
12
2021
entrez:
8
1
2022
pubmed:
9
1
2022
medline:
12
1
2022
Statut:
epublish
Résumé
Creating a box lesion in the posterior wall of the left atrium from the epicardial side of the beating heart remains a challenge. Although a transmural lesion can be created by applying radiofrequency (RF) energy at clampable sites, it is still difficult to create a transmural lesion at unclampable sites because the inner blood flow in the unclampable free wall weakens the thermal effect on the outside. Our aim was to apply the newly developed infrared coagulator to create linear transmural lesions on the beating heart thoracoscopically to treat atrial fibrillation (AF). A 71-year-old male was referred to our hospital with a diagnosis of hypertrophic cardiomyopathy and permanent atrial fibrillation. The patient was first diagnosed with atrial fibrillation 20 years before. Direct current cardioversion had been performed every few years a total of four times, but sinus rhythm restoration had always been temporary. On February 27, 2020, thoracoscopic PV isolation together with infrared roof- and bottom-line ablation to create a box lesion and left atrial appendage amputation (LAAA) were performed. The coagulator could be applied to clinical thoracoscopic surgery to successfully create a box lesion without any complication. The patient restored a regular sinus rhythm, it has been maintained for eleven months, and there have been no adverse events. The infrared coagulator might have enough potential to create transmural lesions on the beating heart in thoracoscopic AF surgery.
Sections du résumé
BACKGROUND
BACKGROUND
Creating a box lesion in the posterior wall of the left atrium from the epicardial side of the beating heart remains a challenge. Although a transmural lesion can be created by applying radiofrequency (RF) energy at clampable sites, it is still difficult to create a transmural lesion at unclampable sites because the inner blood flow in the unclampable free wall weakens the thermal effect on the outside. Our aim was to apply the newly developed infrared coagulator to create linear transmural lesions on the beating heart thoracoscopically to treat atrial fibrillation (AF).
CASE PRESENTATION
METHODS
A 71-year-old male was referred to our hospital with a diagnosis of hypertrophic cardiomyopathy and permanent atrial fibrillation. The patient was first diagnosed with atrial fibrillation 20 years before. Direct current cardioversion had been performed every few years a total of four times, but sinus rhythm restoration had always been temporary. On February 27, 2020, thoracoscopic PV isolation together with infrared roof- and bottom-line ablation to create a box lesion and left atrial appendage amputation (LAAA) were performed. The coagulator could be applied to clinical thoracoscopic surgery to successfully create a box lesion without any complication. The patient restored a regular sinus rhythm, it has been maintained for eleven months, and there have been no adverse events.
CONCLUSIONS
CONCLUSIONS
The infrared coagulator might have enough potential to create transmural lesions on the beating heart in thoracoscopic AF surgery.
Identifiants
pubmed: 34996500
doi: 10.1186/s13019-021-01750-1
pii: 10.1186/s13019-021-01750-1
pmc: PMC8742376
doi:
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1Informations de copyright
© 2022. The Author(s).
Références
Ann Thorac Surg. 1998 Jul;66(1):95-100
pubmed: 9692446
J Am Coll Cardiol. 2013 Jul 9;62(2):103-107
pubmed: 23433566
Arrhythm Electrophysiol Rev. 2017 Dec;6(4):210-216
pubmed: 29326837
Innovations (Phila). 2012 Jan-Feb;7(1):33-8
pubmed: 22576033
Arrhythm Electrophysiol Rev. 2020 Aug;9(2):88-96
pubmed: 32983530
Heart Rhythm. 2017 Oct;14(10):e275-e444
pubmed: 28506916
J Cardiovasc Surg (Torino). 2000 Dec;41(6):835-47
pubmed: 11232966
Ann Thorac Surg. 2009 May;87(5):1592-5
pubmed: 19379916
Ann Thorac Surg. 2017 Dec;104(6):2024-2029
pubmed: 28760469
Ann Thorac Surg. 2005 Sep;80(3):1081-6
pubmed: 16122491
Circulation. 1993 Oct;88(4 Pt 1):1826-31
pubmed: 8403328
J Cardiothorac Surg. 2018 Nov 16;13(1):116
pubmed: 30445977