Analysis of the endocardial stage of treatment of tachyarhythmias after open interventions for atrial fibrillation. Experience of one center

Abstract

AIM: To study EFI parameters and features of recurrent atrial tachyarrhythmias in patients who underwent surgical correction of AF.

MATERIALS AND METHODS: from January 2013 to December 2021, 447 combined interventions were performed to eliminate AF using the labyrinth-3 and left atrial labyrinth techniques with correction of CHD (congenital heart disease) and/or coronary artery disease.

Rhythm disturbances were detected in 57 (12.7%) patients at various follow-up periods. Endovascular interventions were performed in 39 patients. The average follow-up period after the endocardial stage was 34.37 (standard deviation 24.32) months. The median age of patients was 64 (58–67) years, 21 (54%) were men. The patients were divided into 2 groups: group 1 — after the classic biatrial (BA) labyrinth-3 — 23 (59%) patients, group 2 — after the left-atrial variant (LA) labyrinth-3 — 16 (41%) patients.

At the endocardial stage, electrophysiological studies (EFI) were performed to clarify the mechanism of arrhythmia, and ablation eliminated tachyarrhythmia. EFI protocol: revision of the pulmonary veins, determination of the isolation of the posterior wall of the LA assessment of atrial arrhythmia, elimination of arrhythmia, control induction of arrhythmia after ablation. After repeated intervention, patients were observed in the operating clinic every 3 months.

RESULTS: After the endocardial stage, a regular rhythm was determined in 19 (82.6%) patients of the BA group, 13 (92.9%) patients of the LA group (p = 0.914). Relapses in the form of AF were noted in 5 patients (4 — group 1 and 1 — group 2) group (p = 0.306) All relapses of tachyarrhythmia with an irregular cycle (AF) were detected in patients with AF before the endovascular stage In both groups, there were cases of restoration of conduction in the pulmonary veins — 10 (43.5%) patients after BA ablation and 1 (5.3%) patient after LA ablation. There are no recurrences of atrial arrhythmia after ablation of atrial flutter (arrhythmia with a stable cycle).

CONCLUSION: The endocardial stage is highly effective and demonstrates subsequent freedom from atrial arrhythmia in patients who have tachycardia with a regular cycle after both methods of surgical ablation of AF. Recurrent tachyarrhythmia in the form of AF (irregular cycle) is associated with a low probability of maintaining a regular atrial rhythm after a repeated endocardial procedure, due to the presence of structural and electrophysiological changes in the atrial myocardium.

Keywords

atrial fibrillation / atrial flutter / arrhythmia recurrence / “Maze” procedure / catheter ablation / surgical ablation

References

[1] Arakelyan MG, Bockeria LA, Vasilieva EYu, et al. 2020 Clinical guidelines for atrial fibrillation and atrial flutter. Russian Journal of Cardiology. 2021;26(7):190–260. (In Russ.) DOI: 10.15829/1560-4071-2021-4594

[2] Аракелян М.Г., Бокерия Л.А., Васильева Е.Ю., и др. Фибрилляция и трепетание предсердий. Клинические рекомендации 2020 // Российский кардиологический журнал. 2021. Т. 26, № 7. С. 190–260. DOI: 10.15829/1560-4071-2021-4594

[3] Phan K, Xie A, Tsai Y-C, et al. Biatrial ablation vs. left atrial concomitant surgical ablation for treatment of atrial fibrillation: a meta-analysis. Europace. 2015;17(1):38–47. DOI: 10.1093/europace/euu220

[4] Phan K., Xie A., Tsai Y.-C., et al. Biatrial ablation vs. left atrial concomitant surgical ablation for treatment of atrial fibrillation: a meta-analysis // Europace. 2015. Vol. 17, No. 1. P. 38–47. DOI: 10.1093/europace/euu220

[5] Zheng S, Zhang H, Li Y, et al. Comparison of left atrial and biatrial maze procedure in the treatment of atrial fibrillation: A meta-analysis of clinical studies. Thorac Cardiovasc Surg. 2016;64(8):661–671. DOI: 10.1055/s-0035-1554941

[6] Zheng S., Zhang H., Li Y., et al. Comparison of left atrial and biatrial maze procedure in the treatment of atrial fibrillation: A meta-analysis of clinical studies // Thorac Cardiovasc Surg. 2016. Vol. 64, No. 8. P. 661–671. DOI: 10.1055/s-0035-1554941

[7] Andersen KS, Grong K, Hoff P-I, Wahba A. Long-term follow-up after surgery for atrial fibrillation with concomitant open heart surgery. Tidsskr Nor Laegeforen. 2021;141(1). DOI: 10.4045/tidsskr.20.0279

[8] Andersen K.S., Grong K., Hoff P.-I., Wahba A. Long-term follow-up after surgery for atrial fibrillation with concomitant open heart surgery // Tidsskr Nor Laegeforen. 2021. Vol. 141, No. 1. DOI: 10.4045/tidsskr.20.0279

[9] Yurkulieva GA, Abdulkerimov ShM, Ispiryan AYu, et al. Comparative assessment of quality of life of patients with atrial fibrillation after surgical and interventional treatment methods. Annaly aritmologii. 2020;17(2):84–96. (In Russ.) DOI: 10.15275/annaritmol.2020.2.2

[10] Юркулиева Г.А., Абдулкеримов Ш.М., Испирян А.Ю., и др. Сравнительная оценка качества жизни пациентов с фибрилляцией предсердий после хирургического и интервенционного методов лечения // Анналы аритмологии. 2020. Т. 17, № 2. С. 84–96. DOI: 10.15275/annaritmol.2020.2.2

[11] Revishvili AS, Serguladze SYu, Ezhova IV, et al. Rezul’taty khirurgicheskogo lecheniya izolirovannykh form fibrillyatsii predserdii s ispol’zovaniem modifitsirovannoi operatsii «labirint». Annaly aritmologii. 2012;9(3):31–39. (In Russ.)

[12] Ревишвили А.Ш., Сергуладзе С.Ю., Ежова И.В., и др. Результаты хирургического лечения изолированных форм фибрилляции предсердий с использованием модифицированной операции «лабиринт» // Анналы аритмологии. 2012. Т. 9, № 3. С. 31–39.

[13] Elesin DA, Bogachev-Prokof’ev AV, Romanov AB, et al. Thoracoscopic method in treatment of patients with atrial fibrillation. Russian Journal of Cardiology and Cardiovascular Surgery. 2013;6(4):3740. (In Russ.)

[14] Елесин Д.А., Богачев-Прокофьев А.В., Романов А.Б., и др. Торакоскопический метод в лечении пациентов с фибрилляцией предсердий // Кардиология и сердечно-сосудистая хирургия. 2013. Т. 6, № 4. С. 3740.

[15] Cox JL, Schuessler RB, D’Agostino HJ, et al. The surgical treatment of atrial fibrillation. III. Development of a difinitive surgical procedure. J Thorac Cardiovasc Surg. 1991;101(4):569–583. DOI: 10.1016/S0022-5223(19)36684-X

[16] Cox J.L., Schuessler R.B., D’Agostino H.J., et al. The surgical treatment of atrial fibrillation. III. Development of a difinitive surgical procedure // J Thorac Cardiovasc Surg. 1991. Vol. 101, No. 4. P. 569–583. DOI: 10.1016/S0022-5223(19)36684-X

[17] Revishvili AS, Serguladze SYu, Kvasha BI, et al. Early and late outcomes of surgical treatment of lone atrial fibrillation using radiofrequency modification of maze procedure. Journal of Arrhythmology. 2016;(83):23–31. (In Russ.)

[18] Ревишвили А.Ш., Сергуладзе С.Ю., Кваша Б.И., и др. Ближайшие и отдаленные результаты хирургического лечения «изолированных» форм фибрилляции предсердий с помощью радиочастотной модификации операции «лабиринт-V» // Вестник аритмологии. 2016. № 83. С. 23–31.

[19] Bogachev-Prokofyev AV, Pivkin AN, Syrtseva YV, et al. Combinesd treatment of paroxysmal atrial fibrillation in patients with mitral valve disease: analysis of long-term outcomes. Journal of Arrhythmology. 2017;(87):16–22. (In Russ.)

[20] Богачев-Прокофьев А.В., Пивкин А.Н., Сырцева Я.В., и др. Сочетанное лечение пароксизмальной фибрилляции предсердий у пациентов с пороками митрального клапана: анализ отдаленных результатов // Вестник аритмологии. 2017. № 87. С. 16–22.

[21] Antipov GN, Postol AS, Kotov SN, et al. Comparison of biatrial and left atrial maze procedure in concomitant cardiac procedures. Russian Journal of Cardiology and Cardiovascular Surgery. 2020;13(1):17–23. (In Russ.) DOI: 10.17116/kardio20201301117

[22] Антипов Г.Н., Постол А.С., Котов С.Н., и др. Сравнение биатриальной и левопредсердной процедур «лабиринт» при сочетанных операциях на сердце // Кардиология и сердечно-сосудистая хирургия. 2020. Т. 13, № 1. С. 17–23. DOI: 10.17116/kardio20201301117

[23] Cox JL, Churyla A, Malaisrie SC, et al. Hybrid maze procedure for long standing persistent atrial fibrillation. Ann Thoracic Surg. 2018;107(2):610–618. DOI: 10.1016/j.athoracsur.2018.06.064

[24] Cox J.L., Churyla A., Malaisrie S.C., et al. Hybrid maze procedure for long standing persistent atrial fibrillation // Ann Thoracic Surg. 2018. Vol. 107, No. 2. P. 610–618. DOI: 10.1016/j.athoracsur.2018.06.064

[25] Bisleri G, Rosati F, Bontempi L, et al. Hybrid approach for the treatment of long-standing persistent atrial fibrillation: Electrophysiological findings and clinical results. Eur J Cardiothorac Surg. 2013;44(5):919–923. DOI: 10.1093/ejcts/ezt115

[26] Bisleri G., Rosati F., Bontempi L., et al. Hybrid approach for the treatment of long-standing persistent atrial fibrillation: Electrophysiological findings and clinical results // Eur J Cardiothorac Surg. 2013. Vol. 44, No. 5. P. 919–923. DOI: 10.1093/ejcts/ezt115

[27] Gaynor SL, Diato MD, Prasad SM, et al. A prospective, single-center clinical trial of modified Cox maze procedure with bipolar radiofrequency ablation. J Thorac Cardiovasc Surg. 2004;128(4): 535–542. DOI: 10.1016/j.jtcvs.2004.02.044

[28] Gaynor S.L., Diato M.D., Prasad S.M., et al. A prospective, single-center clinical trial of modified Cox maze procedure with bipolar radiofrequency ablation // J Thorac Cardiovasc Surg. 2004. Vol. 128, No. 4. P. 535–542. DOI: 10.1016/j.jtcvs.2004.02.044

[29] Trumello C, Pozzoli A, Mazzone P, et al. Electrophysiological findings and long-term outcomes of percutaneous ablation of atrial arrhythmias after surgical ablation for atrial fibrillation. Eur J Cardiothorac Surg. 2016;49(1):273–280. DOI: 10.1093/ejcts/ezv034

[30] Trumello C., Pozzoli A., Mazzone P., et al. Electrophysiological findings and long-term outcomes of percutaneous ablation of atrial arrhythmias after surgical ablation for atrial fibrillation // Eur J Cardiothorac Surg. 2016. Vol. 49, No. 1. P. 273–280. DOI: 10.1093/ejcts/ezv034

[31] Antipov GN, Postol AS, Kotov SN, et al. Analysis of the causes and frequency of permanent pacemaker implantation after different variants of surgical treatment of atrial fibrillation with combined cardiac surgery. Clinical and Experimental Surgery. Petrovsky journal. 2021;9(4):48–56. (In Russ.) DOI: 10.33029/2308-1198-2021-9-4-48-56

[32] Антипов Г.Н., Постол А.С., Котов С.Н., и др. Анализ причин и частоты имплантации кардиостимуляторов после различных вариантов хирургического лечения фибрилляции предсердий при сочетанных операциях на сердце. Клиническая и экспериментальная хирургия // Журнал имени академика Б.В. Петровского. 2021. Т. 9, № 4. С. 48–56. DOI: 10.33029/2308-1198-2021-9-4-48-56

[33] Lyashenko VV, Ivanchenko AV, Postol AS, et al. Electrophysiological mechanisms of arrhythmias after thoracoscopic Maze procedure. Journal of Arrhythmology. 2020;27(2):5–15. (In Russ.) DOI: 10.35336/VA-2020-2-5-15

[34] Ляшенко В.В., Иванченко А.В., Постол А.С., и др. Электрофизиологические механизмы аритмий после торакоскопической процедуры Maze // Вестник аритмологии. 2020. Т. 27, № 2. С. 5–15. DOI: 10.35336/VA-2020-2-5-15

[35] Chun JKR, Bansch D, Ernst S, et al., Pulmonary vein conduction is the major finding in patients with atrial tachyarrhythmias after intraoperative maze ablation. J Cardiovasc Electrophysiol. 2007;18(4):358–363. DOI: 10.1111/j.1540-8167.2007.00771.x

[36] Chun J.K.R., Bansch D., Ernst S., et al., Pulmonary vein conduction is the major finding in patients with atrial tachyarrhythmias after intraoperative maze ablation // J Cardiovasc Electrophysiol. 2007. Vol. 18, No. 4. P. 358–363. DOI: 10.1111/j.1540-8167.2007.00771.x

[37] Stasiuk YP. Comparison of monopolar and bipolar cox-maze ablation based on clinical data and mathematical modeling. Vestnik NTU KPI. Seriya Radiotekhnika radioapparatostroeniya. 2020;(83): 55–61. (In Russ.)

[38] Стасюк Ю.П. Сравнение монополярной и биполярной абляции cox-maze на основе клинических данных и математического моделирования // Вестник НТУ КПИ. Серия Радиотехника радиоаппаратостроения. 2020. № 83. С. 55–61.

[39] Andersen KS, Grong K, Hoff P, Wahba A. Long-term follow-up after surgery for atrial fibrillation with concomitant open heart surgery. Tidsskrift for Den norske legeforening. 2021;141(1). DOI: 10.4045/tidsskr.20.0279

[40] Andersen K.S., Grong K., Hoff P., Wahba A. Long-term follow-up after surgery for atrial fibrillation with concomitant open heart surgery // Tidsskrift for Den norske legeforening. 2021. Vol. 141, No. 1. DOI: 10.4045/tidsskr.20.0279

[41] Mandoli GE, Pastore MC, Vasilijevaite K, et al. Speckle tracking stress echocardiography: A valuable diagnostic technique or a burden for everyday practice? Echocardiography. 2020;37(12):2123–2129. DOI: 10.1111/echo.14894

[42] Mandoli G.E., Pastore M.C., Vasilijevaite K., et al. Speckle tracking stress echocardiography: A valuable diagnostic technique or a burden for everyday practice? // Echocardiography. 2020. Vol. 37, No. 12. P. 2123–2129. DOI: 10.1111/echo.14894

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