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Successful Endoscopic Surgical Ablation in Persistent Atrial Fibrillation Is Associated With Improved Atrial Function at Short Term Follow-up
Gianluigi Bisleri, Fabrizio Rosati, Ermanna Chiari, Paolo Della Pina, Claudio Muneretto.
University of Brescia Medical School, Brescia, Italy.

OBJECTIVE: Minimally invasive surgical treatment of stand-alone atrial fibrillation has gained popularity especially in presence of persistent atrial fibrillation, thanks to the high rates of success technical feasibility and reduced rate of complications when compared to the original Cox-Maze procedure. Nevertheless, there is paucity of data about the atrial transport function following successful restoration of sinus rhythm (SR) by means of a totally endoscopic, epicardial box lesion set.
METHODS: Among 60 patients with persistent AF scheduled to undergo closed-chest, epicardial beating heart surgical ablation (box lesion set) with a radiofrequency device, a comprehensive echocardiographic assessment of the left atrial(LA) function was performed either pre- and postoperatively; the following parameters were evaluated: LVEF, LA diameter-area-volume, LA total - passive and active emptying fraction, E/A ratio, A’, E’/E’ ratio, deceleration time, LA systolic - early and late diastolic strain. Postoperative evaluation was performed at 6 months following surgical ablation: only 49 patients with stable sinus rhythm were included in the analysis in order to evaluate the impact of the box lesion set following SR restoration.
RESULTS: At 6 months follow-up, there was no considerable difference in the LVEF (pre=61.3±7.2% vs post=63.6±8.7%; p=0.051); however, there was a significant reduction either in terms of LA diameter(pre=47.4±4.2mm vs post=45.8±3.6mm;p=0.012), LA area(pre=28.2±4cm2 vs post=26.1±4.9cm2;p=0.007), LA maximal volume (pre=103.5±29.2mL vs post=95.2±27.1mL; p=0.0024), LA minimum volume (pre=50.8±14.8mL vs post=46.1±11.3mL; p=0.0023) while a considerable improvement in deceleration time (pre=192.7±64.4ms vs post=232.9±132.5ms; p=0.0023). Moreover, there was a recovery of atrial transport function as demonstrated by the recovery active LA emptying fraction of 14.6±4%, a normalisation of the E/A ratio (1.67±0.50) and the A’ value (6.4±2.7).
CONCLUSIONS: Following successful surgical ablation with a box lesion set and stable restoration of sinus rhythm, recovery of an effective atrial transport function could be detected during the first 6 months postoperatively. Longer term analysis is required to confirm further potential improvements over the follow-up period.


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