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Stepwise endo-/epicardial catheter ablation for atrial fibrillation: The Mediterranea approach.
De Martino, Giuseppe; Compagnucci, Paolo; Mancusi, Carmine; Vassallo, Enrico; Calvanese, Claudia; Della Ratta, Giuseppe; Librera, Mariateresa; Franciulli, Marco; Marino, Luigi; Russo, Antonio Dello; Casella, Michela.
Afiliação
  • De Martino G; Arrhythmology and Heart Failure Unit, Mediterranea Hospital, Naples, Italy.
  • Compagnucci P; Department of Biomedical Sciences and Public Health, Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Marche Polytechnic University, Ancona, Italy.
  • Mancusi C; Arrhythmology and Heart Failure Unit, Mediterranea Hospital, Naples, Italy.
  • Vassallo E; Arrhythmology and Heart Failure Unit, Mediterranea Hospital, Naples, Italy.
  • Calvanese C; Arrhythmology and Heart Failure Unit, Mediterranea Hospital, Naples, Italy.
  • Della Ratta G; Arrhythmology and Heart Failure Unit, Mediterranea Hospital, Naples, Italy.
  • Librera M; Echocardiography Laboratory, Mediterranea Hospital, Naples, Italy.
  • Franciulli M; Cardiac Surgery Unit, Mediterranea Hospital, Naples, Italy.
  • Marino L; Cardiac Surgery Unit, Mediterranea Hospital, Naples, Italy.
  • Russo AD; Department of Biomedical Sciences and Public Health, Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Marche Polytechnic University, Ancona, Italy.
  • Casella M; Department of Clinical, Special, and Dental Sciences, Cardiology and Arrhythmology Clinic, University Hospital "Ospedali Riuniti", Marche Polytechnic University, Ancona, Italy.
J Cardiovasc Electrophysiol ; 32(8): 2107-2115, 2021 08.
Article em En | MEDLINE | ID: mdl-34216076
BACKGROUND: Outcomes of catheter ablation (CA) among patients with nonparoxysmal atrial fibrillation (AF) are largely disappointing. OBJECTIVE: We sought to evaluate the feasibility, effectiveness, and safety of a single-stage stepwise endo-/epicardial approach in patients with persistent/longstanding-persistent AF. METHODS: We enrolled 25 consecutive patients with symptomatic persistent (n = 4) or longstanding-persistent (n = 21) AF and at least one prior endocardial procedure, who underwent CA using an endo-/epicardial approach. Our anatomical stepwise protocol included multiple endocardial as well as epicardial (Bachmann's bundle [BB] and ligament of Marshall ablations) components, and entailed ablation of atrial tachycardias emerging during the procedure. The primary outcome was freedom from any AF/atrial tachycardia episode after a 3-month blanking period. The secondary outcome was patients' symptom status during follow-up. RESULTS: The stepwise endo-/epicardial approach allowed sinus rhythm restoration in 72% of patients, either directly (n = 6, 24%) or after AF organization into atrial tachycardia (n = 12, 48%). BB's ablation was commonly implicated in arrhythmia termination. After a median follow-up of 266 days (interquartile range, 96 days), survival free from AF/atrial tachycardia was 88%. Antiarrhythmic drugs could be discontinued in 22 patients (88%). As compared to baseline, more patients were asymptomatic at 9-month follow-up (0% vs. 56%, p = .02). Five patients (20%) developed mild medical complications, whereas one subject (4%) had severe kidney injury requiring dialysis. CONCLUSION: A single-stage endo-/epicardial CA resulted in favorable rhythm and symptom outcomes in a cohort of patients with symptomatic persistent/longstanding-persistent AF and one or more prior endocardial procedures. Epicardial ablation of BB was commonly implicated in procedural success.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Fibrilação Atrial / Ablação por Cateter Tipo de estudo: Diagnostic_studies Limite: Humans Idioma: En Revista: J Cardiovasc Electrophysiol Assunto da revista: ANGIOLOGIA / CARDIOLOGIA / FISIOLOGIA Ano de publicação: 2021 Tipo de documento: Article País de afiliação: Itália

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Fibrilação Atrial / Ablação por Cateter Tipo de estudo: Diagnostic_studies Limite: Humans Idioma: En Revista: J Cardiovasc Electrophysiol Assunto da revista: ANGIOLOGIA / CARDIOLOGIA / FISIOLOGIA Ano de publicação: 2021 Tipo de documento: Article País de afiliação: Itália