Key result
Endocardial application of cryoenergy during surgical ablation of atrial fibrillation achieved 95% completeness of pulmonary vein isolation, compared to 31% and 25% with epicardial approaches on arrested and beating hearts, respectively.
Why the study?
Despite the frequent use of cryoenergy in surgical ablation of AF, the clinical effect of endocardial and epicardial approaches remained unknown.
Does endocardial cryoenergy ablation improve the completeness of lesions and sinus rhythm compared to epicardial ablation in patients undergoing concomitant surgical ablation of atrial fibrillation?
Observational (n=55)
No
Does endocardial cryoenergy ablation improve the completeness of lesions and sinus rhythm compared to epicardial ablation in patients undergoing concomitant surgical ablation of atrial fibrillation?
Endocardial application of cryoenergy during surgical ablation of atrial fibrillation results in significantly higher rates of complete pulmonary vein isolation and box lesions compared to epicardial approaches.
Answers are grounded in this paper and cite their sources.
Endocardial cryoablation was associated with higher lesion completeness; leaves open whether this improves sinus rhythm in randomized trials.
INTRODUCTION: Cryoenergy is the most commonly used method of lesion formation in patients who have undergone surgical ablation of atrial fibrillation. Despite frequent use, the clinical effect of cryoenergy in endocardial and epicardial approaches is unknown. AIM: To compare the effect of various cryoenergy applications on the postoperative incidence of sinus rhythm and completeness of lesions performed. MATERIAL AND METHODS: A total of 55 patients underwent concomitant atrial fibrillation surgical ablation using cryoenergy under various conditions: epicardially during cardiac arrest, epicardially on beating heart, and endocardially. In the postoperative period, patients were invited to attend an electrophysiological examination to assess the completeness of surgical ablation lesions and, if necessary, to complete catheter ablation. RESULTS: Twenty-four patients underwent epicardial ablation on the arrested heart (group 1), 12 patients underwent epicardial ablation on the beating heart (group 2), and 19 patients underwent endocardial ablation (group 3). In the electrophysiological examination, sinus rhythm was present in 71% vs. 83% vs. 89% of patients, respectively. The completeness of pulmonary vein isolation was confirmed in 31% vs. 25% vs. 95% of patients, complete box lesions in 15% vs. 0% vs. 79% of patients, respectively. CONCLUSIONS: Despite the similar clinical effect of surgical ablation in all three approaches, the morphologically most effective use of cryoenergy is endocardial ablation. This approach has a very good result. Our findings further support the endocardial use of cryoenergy during surgical ablation of atrial fibrillation.
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Kurfirst et al. (2020) conducted an observational in Atrial fibrillation (n=55). Endocardial cryoenergy ablation vs. Epicardial cryoenergy ablation (arrested or beating heart) was evaluated on Completeness of pulmonary vein isolation. Endocardial application of cryoenergy during surgical ablation of atrial fibrillation achieved 95% completeness of pulmonary vein isolation, compared to 31% and 25% with epicardial approaches on arrested and beating hearts, respectively.
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