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Successful Endoscopic Surgical Ablation in Patients with Persistent Atrial Fibrillation Is Associated With Recovery of Atrial Transport Function
Gianluigi Bisleri, Fabrizio Rosati, Ermanna Chiari, Elio Gorga, 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 53 patients with persistent AF and 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-operatively (T0) and postoperatively at 6 months (T1) and 12 months (T2); the following parameters were evaluated: LVEF, LA diameter-area-volume, LA total - passive and active emptying fraction, A’ wave, deceleration time. Only patients with stable sinus rhythm during the follow-up (n°=45) were included in the analysis in order to evaluate the impact of the box lesion set following SR restoration.
RESULTS: There was no considerable difference in the LVEF over the follow-up period (T0=60.9±4.6% vs T1=61.9±4.3% vs T2=62.3±6.2%; p=0.392); however, there was a significant reduction either in terms of LA diameter(T0=48.8±3.5% vs T1=44.2±3.6 mm vs T2=43±6.6 mm;p<0.001), LA area(T0=28.2±3.6 cm2 vs T1=24±3.9cm2 vs T2=23.6±3.2 cm2 ;p<0.001), LA maximal volume (T0=99.8±16.1 mL vs T1=84.2±18.6 mL vs vs T2=74.2±18.1 mL; p<0.001), LA minimum volume (T0=73±13 mL vs T1=52.3±14 mL vs T2=43.4±13.8 mL; p<0.001) with a considerable improvement also in deceleration time (T0=165.2.7±31.3 ms vs T1=190.8±41.2 ms vs T2=202.8±78.4 ms; p=0.004). Moreover, there was a recovery of atrial booster function as demonstrated by an active LA emptying fraction of (T0=0% vs T1=21.1±9.2% vs T2=23.9±10%; p<0.001 T1/T2 vs T0), a normalisation of A’ value (T0=0 vs T1=6.7±2.6 vs T2=6.6±1.8; p<0.001 T1/T2 vs T0 ).
CONCLUSIONS: Following successful surgical ablation with a box lesion set and stable restoration of sinus rhythm, a significant recovery of an effective atrial transport function was detected already at 6 months and maintained over the postoperative follow-up period up to 12 months.

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