Mid Term Implantable Cardiac Monitor Follow Up After Thoracoscopic Radiofrequency Ablation
Rustem Tuleutayev1, Alibek Oshakbayev2, Nishanbek Danyarov2, Ualikhan Imammyrzayev2, Timur Ibragimov1, Andrey Kvashnin2, Bauyrzhan Rakishev, Sr.2, Daurenbek Urazbekov2, Askhat Kudaibergen2.
1Republican Research Institute of Cardiology and Internal Medicine, Almaty, Kazakhstan, 2NATIONAL SCIENTIFIC CENTER OF SURGERY named after A.N. SYZGANOVA, Almaty, Kazakhstan.
The aim of the study was to evaluate the mid-term results of the thoracoscopic radiofrequency ablation of the pulmonary veins in treatment of the isolated atrial fibrillation (AF). Methods: Since May 2015 in National Scientific Center of Surgery named after A.N. Syzganov, 48 patients with persistent and long-standing persistent atrial fibrillation underwent the thoracoscopic radiofrequency ablation. The surgical procedure included ablation of the pulmonary veins, coagulation of the Marshal’s ligament, cutting of left atrial appendage and performing of the epicardial mapping to estimate conduction block. Contraindications for procedure were: left atrial appendage thrombosis, sick sinus syndrome, previous open heart surgery, an adhesive process in the pleural cavities (pneumonia, pleuritis), moderate or severe chronic obstructive pulmonary disease. There were totally 48 patients, 38 males and 10 females, the mean age was 58 years (33-74 years), 3 patients with paroxysmal form of AF, 5 patient with persistent AF, 40 patients with long-standing persisting form of AF, the mean duration of AF was 4 years (1.5 months, 21 years), the mean size of the left atrium was 4,15±0,9 cm, 22 patients were after catheter ablation, LV EF was 57.7% (39-73%), 14 patients had a mitral valve regurgitation of the 1-2 degree. In 44 patients cutting of left atrial appendage was performed using surgical stapler. Postoperative amiodorone and warfarin were administered for 6 months. The efficacy of the treatment was estimated by means of cardiac monitor REVEAL XT, the mean follow up time was 498±19 days. Results: All patients were on sinus rhythm after operation and at the time of discharge from hospital. One patient developed an atrial flutter (patient with LV EF 36%) in 30 days after operation and radiofrequency ablation of the cavo-tricuspid isthmus was carried out, 3 patients developed atrial fibrillation in 1, 6 and 12 months after surgical operation. There were no complications in postoperative period. During the follow up period 88% of patients were on sinus rhythm. Conclusion: Thoracoscopic radiofrequency ablation of the pulmonary veins is a safe and effective method of a treatment of atrial fibrillation, especially in patients with large left atrium and ineffective previous catheter ablation.
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