PMID- 36590727
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230103
IS  - 2666-2736 (Electronic)
IS  - 2666-2736 (Linking)
VI  - 12
DP  - 2022 Dec
TI  - Hybrid ablation of persistent and long-standing persistent atrial fibrillation 
      with depressed ejection fraction: A single-center observational study.
PG  - 137-146
LID - 10.1016/j.xjon.2022.08.014 [doi]
AB  - OBJECTIVE: The relationship between atrial fibrillation (AF) and heart failure 
      with depressed ejection fraction (EF) is complex. AF-related tachycardia-mediated 
      cardiomyopathy (TMC) can lead to worsening EF and clinical heart failure. We 
      sought to determine whether a hybrid team ablation approach (HA) can be performed 
      safely and restore normal sinus rhythm in patients with TMC and heart failure and 
      to delineate the effect on heart failure. METHODS: We retrospectively analyzed 
      patients with nonparoxysmal (ie, persistent and long-standing persistent) 
      AF-related TMC with depressed left ventricular EF (LVEF </=40%) and heart failure 
      (New York Heart Association [NYHA] class >/=2) who underwent HA between 2013 and 
      2018 and had at least 1 year of follow-up. Pre-HA and post-HA echocardiograms 
      were compared for LVEF and left atrial (LA) size. Rhythm success was defined as 
      <30 seconds in AF/atrial flutter/atrial tachycardia without class I or III 
      antiarrhythmic drugs. Results are expressed as mean +/- SD and 95% confidence 
      interval (CI) of the mean. RESULTS: Forty patients met the criteria for inclusion 
      in our analysis. The mean patient age was 67 +/- 9.4 years. The majority of 
      patients had long-standing persistent AF (26 of 40; 65%), and the remainder had 
      persistent AF (14 of 40; 35%). All patients had NYHA class II or worse heart 
      failure (NYHA class II, 36 of 40 [90%]; NYHA class III, 4 of 40 [10%]). The mean 
      time in AF pre-HA was 5.6 +/- 6.7 years. All patients received both HA stages. No 
      deaths or strokes occurred within 30 days. Three new permanent pacemakers (7.5%) 
      were placed. Rhythm success was achieved in >60% of patients during a mean 
      3.5 +/- 1.9 years of follow-up. LVEF improved significantly by 12.0% +/- 12.5% (95% 
      CI, 7.85%-16.0%; P < .0001), and mean LA size decreased significantly by 
      0.40 cm +/- 0.85 cm (95% CI, 0.69-0.12 cm; P < .01), with a mean of 3.0 +/- 1.5 years 
      between pre-HA and post-HA echocardiography. NYHA class improved significantly 
      after HA (mean pre-HA NYHA class, 2.1 +/- 0.3 [95% CI, 2.0-2.2]; mean post-HA NYHA 
      class, 1.5 +/- 0.6 [95% CI, 1.3-1.7]; P < .0001). CONCLUSIONS: Thoracoscopic HA of 
      AF in selected patients with TMC heart failure is safe and can result in rhythm 
      success with structural heart changes, including improvements in LVEF and LA 
      size.
CI  - (c) 2022 The Author(s).
FAU - Kiankhooy, Armin
AU  - Kiankhooy A
AD  - Department of Cardiothoracic Surgery, Adventist Health-St Helena Hospital, St 
      Helena, Calif.
FAU - Pierce, Carolyn
AU  - Pierce C
AD  - Department of Cardiothoracic Surgery, Adventist Health-St Helena Hospital, St 
      Helena, Calif.
FAU - Burk, Shelby
AU  - Burk S
AD  - Department of Cardiothoracic Surgery, Adventist Health-St Helena Hospital, St 
      Helena, Calif.
FAU - Phillips, Andrew
AU  - Phillips A
AD  - Virginia Commonwealth University School of Medicine, Richmond, Va.
FAU - Eisenberg, Susan
AU  - Eisenberg S
AD  - Department of Electrophysiology, Adventist Health-St Helena Hospital, St Helena, 
      Calif.
FAU - Dunnington, Gansevoort
AU  - Dunnington G
AD  - Department of Cardiothoracic Surgery, Adventist Health-St Helena Hospital, St 
      Helena, Calif.
LA  - eng
PT  - Journal Article
DEP - 20220921
PL  - Netherlands
TA  - JTCVS Open
JT  - JTCVS open
JID - 101768541
PMC - PMC9801285
OTO - NOTNLM
OT  - AAD, antiarrhythmic drug
OT  - AF, atrial fibrillation
OT  - AFL, atrial flutter
OT  - AT, atrial tachycardia
OT  - CA, catheter ablation
OT  - HA, hybrid ablation
OT  - LA, left atrium/atrial
OT  - LVEF, left ventricular ejection fraction
OT  - NYHA, New York Heart Association
OT  - PV, pulmonary vein
OT  - TMC, tachycardia-mediated cardiomyopathy
OT  - arrythmia surgery
OT  - heart failure
OT  - hybrid ablation
OT  - left ventricular ejection fraction
OT  - tachycardia-mediated cardiomyopathy
EDAT- 2023/01/03 06:00
MHDA- 2023/01/03 06:01
PMCR- 2022/09/21
CRDT- 2023/01/02 04:33
PHST- 2022/05/24 00:00 [received]
PHST- 2022/08/13 00:00 [revised]
PHST- 2022/08/29 00:00 [accepted]
PHST- 2023/01/02 04:33 [entrez]
PHST- 2023/01/03 06:00 [pubmed]
PHST- 2023/01/03 06:01 [medline]
PHST- 2022/09/21 00:00 [pmc-release]
AID - S2666-2736(22)00352-7 [pii]
AID - 10.1016/j.xjon.2022.08.014 [doi]
PST - epublish
SO  - JTCVS Open. 2022 Sep 21;12:137-146. doi: 10.1016/j.xjon.2022.08.014. eCollection 
      2022 Dec.