Open AccessStaged surgical treatment of patients with combination of non-paroxysmal form of atrial fibrillation and isthmus-dependent atrial flutter
Author(s) -
Sergei Vachev,
S. V. Koroljov,
А.С. Зотов,
Robert Khabazov,
R. I. Troitsky
Publication year - 2020
Publication title -
vestnik aritmologii
Language(s) - English
Resource type - Journals
eISSN - 2658-7327
pISSN - 1561-8641
DOI - 10.35336/va-2020-1-30-33
Subject(s) - medicine , atrial flutter , atrial fibrillation , supraventricular arrhythmia , cardiology , catheter ablation , waiting period , radiofrequency ablation , surgery , ablation , anesthesia , toxicology , biology
Objective . To improve the results of treatment for the patients with non-paroxysmal atrial fibrillation (AF) in combination with isthmus-dependent (typical) atrial flutter (AFL) by determining the optimal surgical tactics. Material and methods . The research based on the study of treatment results for 37 patients who are consequentially underwent thoracoscopic radiofrequency fragmentation (TRF) of the left atrium (LA) in the period from April 2017 to December 2019. All of the patients suffered from a combination of 2 types of arrhythmias: non-paroxysmal AF and AFL. Depending on history of catheter ablation (CA) of cavotricuspid isthmus (CTI) before TRF, all patients divided into 2 groups: group 1 - there was anamnesis of CA of CTI before TRF (N = 16; 43%); group 2 - there was no CA of CTI before TRF of the LA (N = 21; 57%). In the postoperative period, all patients underwent examination and interviewed regarding cardiac arrhythmias. At the time of April 1, 2020, information about heart rhythm and its disorders during follow-up period was received from 100% of patients. The duration of the follow-up period after TRF was 17 (3; 35) months. Results . There was no supraventricular tachyarrhythmias (SVT) during all follow-up period after TRF among the patients of group 1. There was 8 patients (38%) of group 2 with AFL, which is developed in the period from 1 to 6 months after TRF. All these patients underwent a CA of CTI after the end of a “blanking” period. There was 2 of 8 patients with developing of SVT after CA of CTI. The source of new rhythm disorder was the ablation line formed during TRF on the roof of the LA. Conclusion . In order to achieve long-term freedom from SVT requiring surgical intervention in patients suffering from a non-paroxysmal AF in combination with a typical AFL it is reasonable to perform catheter radiofrequency ablation of CTI at the first stage before TFR of the LA.