Expanding Our Horizons: A Combined Minimally Invasive Approach To Concomitant Atrial Fibrillation And Coronary Artery Disease
Greogory Duncan Rushing, Marc P. Pelletier, Pablo F. Ruda Vega.
University Hospitals, Case Western Reserve University, Cleveland, OH, USA.
BACKGROUND: Minimally invasive epicardial ablation is an increasing useful tool in patients who have failed catheter based therapies, for longstanding persistent atrial fibrillation. In our division minimally invasive coronary bypass, MIDCAB (LIMA to LAD), has become the therapy of choice to treat proximal LAD lesions not suitable for stenting. In the aging population, these diseases, often occur concomitantly.
METHODS: Two patients with longstanding persistent atrial fibrillation and proximal LAD disease were identified for a combined minimally invasive approach. Subxiphoid pericardiostomy was utilized for epicardial posterior left atrial ablation; mini left anterior thoracotomy was used to exclude the left atrial appendage and bypass the LAD. The subxiphoid incision was also utilized to place a tissue stabilizer for off pump anastomosis.
RESULTS: The patients were a 69 year old man and 84 year old woman respectively. Each had a 4 year duration of longstanding persistent atrial fibrillation. Both were discovered to have stable proximal LAD lesions in work-up for surgical ablation. Each presented with at least two failed catheter ablations. Follow up is six months. There was 0% burden atrial fibrillation on 7 day rhythm monitor, there were no myocardial infarctions, no strokes.
CONCLUSIONS: A combined minimally invasive approach is technically feasible; and should be offered to patients with proximal LAD disease and concomitant longstanding persistent atrial fibrillation. Screening of these patient populations should be regularly performed.
LEGEND: Position and skin incisions for our combined approach. 
Back to 2023 Display ePosters