Novel Technique for Box-Lesion Ablation of Atrial Fibrillation Combined with Off-Pump Coronary Surgery.

INTRODUCTION: We propose a new technique for box-lesion ablation combined with off-pump coronary artery bypass grafting for the treatment of patients with coronary artery disease and paroxysmal or persistent atrial fibrillation. METHODS: Eight male patients with paroxysmal (n=2) or persistent atrial fibrillation (n=6) and coronary artery disease underwent box-lesion ablation combined with off-pump coronary artery bypass grafting. Box-lesion ablation was performed using a bipolar flexible clamping device with irrigated electrodes which was originally designed for thoracoscopic epicardial ablation. RESULTS: Complete revascularization was performed in all patients. There were no deaths or major complications. At a median follow-up of 14 months, seven patients (87.5%) were in sinus rhythm. CONCLUSION: Box-lesion ablation can be easily and effectively combined with coronary artery surgery in an off-pump setting.

Novel Technique for Box-Lesion Ablation of Atrial Fibrillation Combined with Off-Pump Coronary Surgery

ABSTRACT Introduction: We propose a new technique for box-lesion ablation combined with off-pump coronary artery bypass grafting for the treatment of patients with coronary artery disease and paroxysmal or persistent atrial fibrillation. Methods: Eight male patients with paroxysmal (n=2) or persistent atrial fibrillation (n=6) and coronary artery disease underwent box-lesion ablation combined with off-pump coronary artery bypass grafting. Box-lesion ablation was performed using a bipolar flexible clamping device with irrigated electrodes which was originally designed for thoracoscopic epicardial ablation. Results: Complete revascularization was performed in all patients. There were no deaths or major complications. At a median follow-up of 14 months, seven patients (87.5%) were in sinus rhythm. Conclusion: Box-lesion ablation can be easily and effectively combined with coronary artery surgery in an off-pump setting.

Engineering of Numerous Moiré Superlattices in Twisted Multilayer Graphene for Twistronics and Straintronics Applications.

Because of their unique atomic structure, 2D materials are able to create an up-to-date paradigm in fundamental science and technology on the way to engineering the band structure and electronic properties of materials on the nanoscale. One of the simplest methods along this path is the superposition of several 2D nanomaterials while simultaneously specifying the twist angle between adjacent layers (θ), which leads to the emergence of Moiré superlattices. The key challenge in 2D nanoelectronics is to obtain a nanomaterial with numerous Moiré superlattices in addition to a high carrier mobility in a stable and easy-to-fabricate material. Here, we demonstrate the possibility of synthesizing twisted multilayer graphene (tMLG) with a number of monolayers NL = 40-250 and predefined narrow ranges of θ = 3-8°, θ = 11-15°, and θ = 26-30°. A 2D nature of the electron transport is observed in the tMLG, and its carrier mobilities are close to those of twisted bilayer graphene (tBLG) (with θ = 30°) between h-BN layers. We demonstrate an undoubtful presence of numerous Moiré superlattices simultaneously throughout the entire tMLG thickness, while the periods of these superlattices are rather close to each other. This offers a challenge of producing a next generation of devices for nanoelectronics, twistronics, and neuromorphic computing for large data applications.

Simultaneous Thoracoscopic Approach in a Patient with Long-Standing Persistent Atrial Fibrillation and Primary Lung Cancer: the First Described Case.

Cardiac rhythm disorders are common in many patients with cancer. The management of synchronous long-standing persistent atrial fibrillation and pulmonary lesions remains a serious surgical dilemma due to the lack of clinical data and surgical guidelines. To the best of our knowledge, this is the first described case of simultaneous thoracoscopic pulmonary segmentectomy and left atrial posterior wall and pulmonary vein isolation combined with left atrial appendage resection in a patient with early-stage primary lung cancer and long-standing persistent atrial fibrillation.

Simultaneous thoracoscopic approach in a patient with long-standing persistent atrial fibrillation and primary lung cancer: the first described case

Abstract Cardiac rhythm disorders are common in many patients with cancer. The management of synchronous long-standing persistent atrial fibrillation and pulmonary lesions remains a serious surgical dilemma due to the lack of clinical data and surgical guidelines. To the best of our knowledge, this is the first described case of simultaneous thoracoscopic pulmonary segmentectomy and left atrial posterior wall and pulmonary vein isolation combined with left atrial appendage resection in a patient with early-stage primary lung cancer and long-standing persistent atrial fibrillation.

Thoracoscopic Pulmonary Vein and Left Atrial Posterior Wall Isolation Combined with Left Atrial Appendage Resection in Patients with Long-Standing Persistent Atrial Fibrillation.

OBJECTIVE: To evaluate the efficacy and safety of a modified technique for totally thoracoscopic left atrial posterior wall and pulmonary vein isolation in patients with long-standing persistent atrial fibrillation. METHODS: From April 2017 to December 2018, we included in this study 28 consecutive patients who underwent thoracoscopic left atrial posterior wall and pulmonary vein radiofrequency isolation combined with left atrial appendage resection. We used a device with irrigated electrodes (Medtronic Cardioblate Gemini-s). The original surgical technique "GALAXY" proposed by Doty in 2012 was modified. The number of ablations was significantly increased, and frequent position changing of the ablation device and change of device angulation were added. RESULTS: Sinus rhythm was restored in all patients. There was no operative mortality, no myocardial infarction, and no stroke or transient ischemic attack. One patient required sternotomy and another survived left anterolateral thoracotomy due to bleeding. A 180-day follow-up (24-hour Holter monitoring) revealed no sign of recurrence of atrial fibrillation or other supraventricular arrhythmia in any patient. Mean follow-up was nine months (range: 6-16 months). At the last follow-up, 26 patients (92,9%) were in sinus rhythm (24-hour Holter monitoring). CONCLUSION: A frequent ablation device position changing during the surgery makes it possible to achieve complete left atrial posterior wall and pulmonary veins isolation.  An increased number of applications allows to avoid a false positive transmural damage assessment showed by impedance drop. Also, frequent position changing of the ablation device and increased number of applications do not affect the number of postoperative complications.

Thoracoscopic pulmonary vein and left atrial posterior wall isolation combined with left atrial appendage resection in patients with long-standing persistent atrial fibrillation

Abstract Objective: To evaluate the efficacy and safety of a modified technique for totally thoracoscopic left atrial posterior wall and pulmonary vein isolation in patients with long-standing persistent atrial fibrillation. Methods: From April 2017 to December 2018, we included in this study 28 consecutive patients who underwent thoracoscopic left atrial posterior wall and pulmonary vein radiofrequency isolation combined with left atrial appendage resection. We used a device with irrigated electrodes (Medtronic Cardioblate Gemini-s). The original surgical technique "GALAXY" proposed by Doty in 2012 was modified. The number of ablations was significantly increased, and frequent position changing of the ablation device and change of device angulation were added. Results: Sinus rhythm was restored in all patients. There was no operative mortality, no myocardial infarction, and no stroke or transient ischemic attack. One patient required sternotomy and another survived left anterolateral thoracotomy due to bleeding. A 180-day follow-up (24-hour Holter monitoring) revealed no sign of recurrence of atrial fibrillation or other supraventricular arrhythmia in any patient. Mean follow-up was nine months (range: 6-16 months). At the last follow-up, 26 patients (92,9%) were in sinus rhythm (24-hour Holter monitoring). Conclusion: A frequent ablation device position changing during the surgery makes it possible to achieve complete left atrial posterior wall and pulmonary veins isolation. An increased number of applications allows to avoid a false positive transmural damage assessment showed by impedance drop. Also, frequent position changing of the ablation device and increased number of applications do not affect the number of postoperative complications.