Right Atrium Positioning For Exposure Of Right Pulmonary Veins During Off-Pump Atrial Fibrillation Ablation
Grzegorz Suwalski1, Robert Emery2, Jakub Mróz1, Kamil Kaczejko1, Przemysław Szałański1, Leszek Gryszko1, Andrzej Cwetsch3, Andrzej Skrobowski3.
1Department of Cardiac Surgery, Military Institute of Medicine, Warsaw, Poland, 2Department of Cardiac Surgery, St Josephs Hospital, St. Paul, MN, USA, 3Department of Cardiology, Military Institute of Medicine, Warsaw, Poland.
OBJECTIVE: Concomitant surgical ablation of atrial fibrillation (AF) is recommended for patients undergoing off-pump coronary revascularization in the presence of this arrhythmia. Achievement of optimal visualization of pulmonary veins while maintaining stable hemodynamic conditions is crucial for proper completion of the ablation procedure. This study evaluates the safety and feasibility of right atrial positioning using a suction based cardiac positioner as opposed to compressive maneuvers for exposure during off-pump surgical ablation for AF.
METHODS: Thirty-four consecutive patients underwent pulmonary vein isolation, ganglionated plexi (GP) ablation and left atrial appendage occlusion during off-pump coronary artery bypass grafting. Right atrial suction positioning was used to visualize right pulmonary veins. Safety and feasibility end-points were analyzed intraoperatively and in the early postoperative course.
RESULTS: In all patients, right atrial positioning created optimal conditions to complete transverse and oblique sinus blunt dissection, correct placement of a bipolar ablation probe, detection and ablation of GP and conduction block assessment. In all patients, this entire right sided ablation procedure was completed with a single exposure maneuver. Feasibility end-points were achieved in all study patients.
CONCLUSIONS: This report documents the safety and feasibility of right atrial exposure using a suction based cardiac positioner to complete ablation for AF concomitant with off-pump coronary revascularization. This technique may be widely adopted to create stable hemodynamic conditions and optimal visualization of the right pulmonary veins.
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