Robotic-Assisted Epicardial Hybrid Ablation and Left Appendage Closure in Persistent Atrial Fibrillation: First European Experience
Abstract
:1. Introduction
2. Material and Methods
2.1. Study Population
2.2. Preoperative Diagnostic Workup
2.3. Surgical Technique
2.4. Statistical Analysis
3. Results
3.1. Study Population
3.2. Intra- and Postoperative Results
4. Discussion
5. Limitations of the Study
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Kirchhof, P.; Benussi, S.; Kotecha, D.; Ahlsson, A.; Atar, D.; Casadei, B.; Castella, M.; Diener, H.C.; Heidbuchel, H.; Hendriks, J.; et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur. J. Cardio-Thoracic. Surg. 2016, 50, E1–E88. [Google Scholar] [CrossRef]
- Boriani, G.; Pettorelli, D. Atrial fibrillation burden and atrial fibrillation type: Clinical significance and impact on the risk of stroke and decision making for long-term anticoagulation. Vascul. Pharmacol. 2016, 83, 26–35. [Google Scholar] [CrossRef]
- Charitos, E.I.; Pürerfellner, H.; Glotzer, T.V.; Ziegler, P.D. Clinical classifications of atrial fibrillation poorly reflect its temporal persistence: Insights from 1195 patients continuously monitored with implantable devices. J. Am. Coll. Cardiol. 2014, 63, 2840–2848. [Google Scholar] [CrossRef]
- Boriani, G.; Diemberger, I.; Ziacchi, M.; Valzania, C.; Gardini, B.; Cimaglia, P.; Martignani, C.; Biffi, M. AF burden is important—Fact or fiction? Int. J. Clin. Pract. 2014, 68, 444–452. [Google Scholar] [CrossRef]
- Haïssaguerre, M.; Jaïs, P.; Shah, D.C.; Takahashi, A.; Hocini, M.; Quiniou, G.; Garrigue, S.; Mouroux, A.L.; Métayer, P.L.; Clémenty, J. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N. Engl. J. Med. 1998, 339, 659–666. [Google Scholar] [CrossRef]
- Gaynor, S.L.; Schuessler, R.B.; Bailey, M.S.; Ishii, Y.; Boineau, J.P.; Gleva, M.J.; Cox, J.L.; Damiano, R.J. Surgical treatment of atrial fibrillation: Predictors of late recurrence. J. Thorac. Cardiovasc. Surg. 2005, 129, 104–111. [Google Scholar] [CrossRef]
- Chew, D.S.; Black-Maier, E.; Loring, Z.; Noseworthy, P.A.; Packer, D.L.; Exner, D.V.; Mark, D.B.; Piccini, J.P. Diagnosis-to-Ablation Time and Recurrence of Atrial Fibrillation Following Catheter Ablation: A Systematic Review and Meta-Analysis of Observational Studies. Circ. Arrhythmia Electrophysiol. 2020, 13, E008128. [Google Scholar] [CrossRef]
- Bisleri, G.; Muneretto, C. Innovative monolateral approach for closed-chest atrial fibrillation surgery. Ann. Thorac. Surg. 2005, 80, 3–6. [Google Scholar] [CrossRef]
- Argenziano, M.; Oz, M.C.; Kohmoto, T.; Morgan, J.; Dimitui, J.; Mongero, L.; Beck, J.; Smith, C.R. Totally endoscopic atrial septal defect repair with robotic assistance. Circulation 2003, 108 (Suppl. S1), II191–II194. [Google Scholar] [CrossRef] [PubMed]
- Saltman, A.E.; Rosenthal, L.S.; Francalancia, N.A.; Lahey, S.J. A completely endoscopic approach to microwave ablation for atrial fibrillation. Heart Surg. Forum 2003, 6, E38–E41. [Google Scholar]
- Churyla, A.; Passman, R.; McCarthy, P.M.; Kislitsina, O.N.; Kruse, J.; Cox, J.L. Staged hybrid totally thoracoscopic maze and catheter ablation for atrial fibrillation. J. Cardiovasc. Electrophysiol. 2022, 33, 1961–1965. [Google Scholar] [CrossRef]
- Marini, M.; Pannone, L.; Della Rocca, D.G.; Branzoli, S.; Bisignani, A.; Mouram, S.; Del Monte, A.; Monaco, C.; Gauthey, A.; Eltsov, I.; et al. Hybrid Ablation of Atrial Fibrillation: A Contemporary Overview. J. Cardiovasc. Dev. Dis. 2022, 9, 302. [Google Scholar] [CrossRef]
- Eranki, A.; Wilson-Smith, A.; Flynn, C.; Williams, M.; Manganas, C. Mid term freedom from atrial fibrillation following hybrid ablation, a systematic review and meta-analysis. J. Cardiothorac. Surg. 2023, 18, 155. [Google Scholar] [CrossRef]
- Chugh, S.S.; Havmoeller, R.; Narayanan, K.; Singh, D.; Rienstra, M.; Benjamin, E.J.; Gillum, R.F.; Kim, Y.H.; McAnulty, J.H.; Zheng, Z.J.; et al. Worldwide epidemiology of atrial fibrillation: A global burden of disease 2010 study. Circulation 2014, 129, 837–847. [Google Scholar] [CrossRef]
- Colilla, S.; Crow, A.; Petkun, W.; Singer, D.E.; Simon, T.; Liu, X. Estimates of current and future incidence and prevalence of atrial fibrillation in the U.S. adult population. Am. J. Cardiol. 2013, 112, 1142–1147. [Google Scholar] [CrossRef]
- Philpott, J.M.; Zemlin, C.W.; Cox, J.L.; Stirling, M.; Mack, M.; Hooker, R.L.; Morris, A.; Heimansohn, D.A.; Longoria, J.; Gandhi, D.B.; et al. The ABLATE trial: Safety and efficacy of cox Maze-IV using a bipolar radiofrequency ablation system. Ann. Thorac. Surg. 2015, 100, 1541–1548. [Google Scholar] [CrossRef]
- Wolf, R.K. Surgical Treatment of Atrial Fibrillation. Methodist. Debakey Cardiovasc. J. 2021, 17, 56–64. [Google Scholar] [CrossRef]
- Wolf, R.K.; Schneeberger, E.W.; Osterday, R.; Miller, D.; Merrill, W.; Flege, J.B.; Gillinov, A.M. Video-assisted bilateral pulmonary vein isolation and left atrial appendage exclusion for atrial fibrillation. J. Thorac. Cardiovasc. Surg. 2005, 130, 797–802. [Google Scholar] [CrossRef]
- Wudel, J.H.; Chaudhuri, P.; Hiller, J.J. Video-Assisted Epicardial Ablation and Left Atrial Appendage Exclusion for Atrial Fibrillation: Extended Follow-Up. Ann. Thorac. Surg. 2008, 85, 34–38. [Google Scholar] [CrossRef]
- Van Den, E.J.; Melly, L.; Torregrossa, G.; Oosterlinck, W. Robotic cardiac surgery: What the young surgeon should know. Brazilian J. Cardiovasc. Surg. 2020, 35, 3. [Google Scholar]
- Cerny, S.; Oosterlinck, W.; Onan, B.; Singh, S.; Segers, P.; Bolcal, C.; Alhan, C.; Navarra, E.; Pettinari, M.; Van, R.F.; et al. Robotic Cardiac Surgery in Europe: Status 2020. Front. Cardiovasc. Med. 2022, 8, 827515. [Google Scholar] [CrossRef]
- Wats, K.; Kiser, A.; Makati, K.; Sood, N.; DeLurgio, D.; Greenberg, Y.; Yang, F. The Convergent Atrial Fibrillation Ablation Procedure: Evolution of a Multidisciplinary Approach to Atrial Fibrillation Management. Arrhythmia Electrophysiol. Rev. 2020, 9, 88–96. [Google Scholar] [CrossRef]
- Yokokawa, M.; Chugh, A.; Ulfarsson, M.; Takaki, H.; Han, L.; Yoshida, K.; Sugimachi, M.; Morady, F.; Oral, H. Effect of linear ablation on spectral components of atrial fibrillation. Heart Rhythm 2010, 7, 1732–1737. [Google Scholar] [CrossRef]
- Segerson, N.M.; Daccarett, M.; Badger, T.J.; Shabaan, A.; Akoum, N.; Fish, E.N.; Rao, S.; Burgon, N.S.; Adjei-Poku, Y.; Kholmovski, E.; et al. Magnetic Resonance Imaging-Confirmed Ablative Debulking of the Left Atrial Posterior Wall and Septum for Treatment of Persistent Atrial Fibrillation: Rationale and Initial Experience. J. Cardiovasc. Electrophysiol. 2010, 21, 126–132. [Google Scholar] [CrossRef]
- Suenari, K.; Chen, Y.C.; Kao, Y.H.; Cheng, C.C.; Lin, Y.K.; Chen, Y.J.; Chen, S.A. Discrepant electrophysiological characteristics and calcium homeostasis of left atrial anterior and posterior myocytes. Basic Res. Cardiol. 2011, 106, 65–74. [Google Scholar] [CrossRef]
- Jongbloed, M.R.M.; Schalij, M.J.; Poelmann, R.E.; Blom, N.A.; Fekkes, M.L.; Wang, Z.; Fishman, G.I.; Gittenberger-De Groot, A.C. Embryonic conduction tissue: A spatial correlation with adult arrhythmogenic areas. J. Cardiovasc. Electrophysiol. 2004, 15, 349–355. [Google Scholar] [CrossRef]
- Marrouche, N.F.; Wazni, O.; McGann, C.; Greene, T.; Dean, J.M.; Dagher, L.; Kholmovski, E.; Mansour, M.; Marchlinski, F.; Wilber, D.; et al. Effect of MRI-Guided Fibrosis Ablation vs Conventional Catheter Ablation on Atrial Arrhythmia Recurrence in Patients with Persistent Atrial Fibrillation: The DECAAF II Randomized Clinical Trial. JAMA 2022, 327, 2296–2305. [Google Scholar] [CrossRef]
- DeLurgio, D.B.; Ferguson, E.; Gill, J.; Blauth, C.; Oza, S.; Mostovych, M.; Awasthi, Y.; Ndikintum, N.; Crossen, K. Convergence of Epicardial and Endocardial RF Ablation for the Treatment of Symptomatic Persistent AF (CONVERGE Trial): Rationale and design. Am. Heart J. 2020, 224, 182–191. [Google Scholar] [CrossRef]
- Lakkireddy, D.; Sridhar Mahankali, A.; Kanmanthareddy, A.; Lee, R.; Badhwar, N.; Bartus, K.; Atkins, D.; Bommana, S.; Cheng, J.; Rasekh, A.; et al. Left atrial appendage ligation and ablation for persistent atrial fibrillation: The LAALA-AF registry. JACC Clin. Electrophysiol. 2015, 1, 153–160. [Google Scholar] [CrossRef]
- Di Biase, L.; Burkhardt, J.D.; Mohanty, P.; Mohanty, S.; Sanchez, J.E.; Trivedi, C.; Güneş, M.; Gökoğlan, Y.; Gianni, C.; Horton, R.P.; et al. Left Atrial Appendage Isolation in Patients with Longstanding Persistent AF Undergoing Catheter Ablation: BELIEF Trial. J. Am. Coll. Cardiol. 2016, 68, 1929–1940. [Google Scholar] [CrossRef]
- Starck, C.T.; Steffel, J.; Emmert, M.Y.; Plass, A.; Mahapatra, S.; Falk, V.; Salzberg, S.P. Epicardial left atrial appendage clip occlusion also provides the electrical isolation of the left atrial appendage. Interact. Cardiovasc. Thorac. Surg. 2012, 15, 416–418. [Google Scholar] [CrossRef]
- van der Heijden, C.A.; Weberndörfer, V.; Vroomen, M.; Luermans, J.G.; Chaldoupi, S.M.; Bidar, E.; Vernooy, K.; Maessen, J.G.; Pison, L.; van Kuijk, S.M.J.; et al. Hybrid Ablation Versus Repeated Catheter Ablation in Persistent Atrial Fibrillation: A Randomized Controlled Trial. JACC Clin. Electrophysiol. 2023, 9, 1013–1023. [Google Scholar] [CrossRef]
- Nasso, G.; Lorusso, R.; Di Bari, N.; Condello, I.; Agró, F.E.; Fiore, F.; Bonifazi, R.; Santarpino, G.; Speziale, G. Hybrid approach for long-standing persistent atrial fibrillation: Immediate versus staged treatment. J. Cardiothorac. Surg. 2022, 17, 274. [Google Scholar] [CrossRef]
Number of Patients = 18 | |
---|---|
Age (years) | 64 ± 5 |
Female sex, n (%) | 3 (17) |
Family AF History, n (%) | 4 (22) |
Hypertension, n (%) | 12 (67) |
Diabetes, n (%) | 4 (22) |
Chronic obstructive pulmonary disease, n (%) | 1 (6) |
Dyslipidemia, n (%) | 11 (61) |
Coronary artery disease, n (%) | 0 (0%) |
Peripheral vascular disease, n (%) | 0 |
Stroke, n (%) | 0 |
Obesity, n (%) | 9 (50) |
CHA2DS2-VASc score | 2 ± 1 |
Has-bled score | 2 ± 1 |
Average AF duration (years) | 4 ± 2 |
NYHA class I-II, n (%) | 18 (100) |
Previous CVE, n (%) | 6 (33) |
Previous PVI transcatheter ablation, n (%) | 7 (39) |
Previous transcatheter LA exclusion, n (%) | 1(4) |
Anatomical findings | |
LAA morphology | |
Cauliflower, n (%) | 4 (22) |
Chicken Wing, n (%) | 6 (33) |
Windsock, n (%) | 3 (17) |
Cactus, n (%) | 5 (28) |
MRI Left Atrial Volume (mL) | 156 ± 37.7 |
Mean EF (%) | 57 ± 6 |
Number of Patients = 18 | |
---|---|
Concomitant AF ablation + LAA exclusion | 100% (18) |
Operative time (min) overall | 142 ± 22 |
LAA clip size (mm) | |
40 | 4 |
45 | 10 |
50 | 4 |
CPB required | 0% |
Convertion to full sternotomy or minithoracotomy | 0% |
Extubation in operative room | 83% (15) |
Mean mechanical ventilation time (Hours) | 3 ± 1 |
Mean ICU time (hours) | 16 ± 3 |
Postoperative stroke | 0 |
Hospital mortality | 0 |
Mean length of stay in hospital (days) | 3 ± 1 |
Rhythm at discharge | |
Sinusal rhythm | 67% (12) |
Atrial flutter | 6% (1) |
Atrial fibrillation | 27% (5) |
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Agnino, A.; Giroletti, L.; Graniero, A.; Gerometta, P.; Parrinello, M.; Albano, G.; Celentano, E.; Cristiano, E.; Nasso, G.; de Groot, N.M.S. Robotic-Assisted Epicardial Hybrid Ablation and Left Appendage Closure in Persistent Atrial Fibrillation: First European Experience. J. Clin. Med. 2024, 13, 1563. https://doi.org/10.3390/jcm13061563
Agnino A, Giroletti L, Graniero A, Gerometta P, Parrinello M, Albano G, Celentano E, Cristiano E, Nasso G, de Groot NMS. Robotic-Assisted Epicardial Hybrid Ablation and Left Appendage Closure in Persistent Atrial Fibrillation: First European Experience. Journal of Clinical Medicine. 2024; 13(6):1563. https://doi.org/10.3390/jcm13061563
Chicago/Turabian StyleAgnino, Alfonso, Laura Giroletti, Ascanio Graniero, Piersilvio Gerometta, Matteo Parrinello, Giovanni Albano, Eduardo Celentano, Ernesto Cristiano, Giuseppe Nasso, and Natasja M. S. de Groot. 2024. "Robotic-Assisted Epicardial Hybrid Ablation and Left Appendage Closure in Persistent Atrial Fibrillation: First European Experience" Journal of Clinical Medicine 13, no. 6: 1563. https://doi.org/10.3390/jcm13061563
APA StyleAgnino, A., Giroletti, L., Graniero, A., Gerometta, P., Parrinello, M., Albano, G., Celentano, E., Cristiano, E., Nasso, G., & de Groot, N. M. S. (2024). Robotic-Assisted Epicardial Hybrid Ablation and Left Appendage Closure in Persistent Atrial Fibrillation: First European Experience. Journal of Clinical Medicine, 13(6), 1563. https://doi.org/10.3390/jcm13061563