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Insights from advancements and pathbreaking research on the minimally invasive treatment of atrial fibrillation

Atrial fibrillation (AF) remains the most common cardiac arrhythmia with increasing prevalence in developed and aging countries. Pharmacological antiarrhythmic therapy has low effectiveness and is limited by its toxicity. Developed in 1987 by James Cox surgical ablation of AF called MAZE procedure w...

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Autores principales: Witkowska, Anna, Suwalski, Piotr
Formato: Online Artículo Texto
Lenguaje:English
Publicado: AME Publishing Company 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8024848/
https://www.ncbi.nlm.nih.gov/pubmed/33841986
http://dx.doi.org/10.21037/jtd-20-1876
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author Witkowska, Anna
Suwalski, Piotr
author_facet Witkowska, Anna
Suwalski, Piotr
author_sort Witkowska, Anna
collection PubMed
description Atrial fibrillation (AF) remains the most common cardiac arrhythmia with increasing prevalence in developed and aging countries. Pharmacological antiarrhythmic therapy has low effectiveness and is limited by its toxicity. Developed in 1987 by James Cox surgical ablation of AF called MAZE procedure was very effective, but due to its invasiveness and complexity was not widely adopted. Landmark research done by Haissaguerre in 1998 initiated a new approach for treatment namely percutaneous catheter ablation, which remains a class I/A indication in symptomatic paroxysmal AF refractory to optimal medical therapy. However, its efficacy in patients with persistent atrial fibrillation (PSAF) is far from satisfactory. Recent advancements in devices and techniques of minimally invasive surgical ablation show very good results in the treatment of PSAF. Current guidelines equate surgical with catheter ablation within the scope of efficacy indicating that both may be considered as an effective and safe treatment option for patients with persistent forms of arrhythmia. The higher efficacy of surgical ablation was confirmed at a 7-year follow-up of FAST trial with recurrence rate as high as 87% in catheter arm compared with 56% in thoracoscopic ablation arm. A new concept of the invasive treatment of AF consisting of combined surgical (epicardial) and electrophysiological (endocardial) was introduced in 2009. Recently experts’ opinions and published data suggest that the proper hybrid treatment consisting of a planned combination of surgical and catheter ablation may give even better results. One of the most invaluable benefits of surgical ablations is the possibility of concomitant occlusion of the left atrial appendage. Recently good results have been reported for the novel epicardial clip for closing the left atrial appendage, which is placed in the deployment loop on a disposable holder.
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spelling pubmed-80248482021-04-08 Insights from advancements and pathbreaking research on the minimally invasive treatment of atrial fibrillation Witkowska, Anna Suwalski, Piotr J Thorac Dis Review Article on Minimally Invasive Cardiac Surgery Atrial fibrillation (AF) remains the most common cardiac arrhythmia with increasing prevalence in developed and aging countries. Pharmacological antiarrhythmic therapy has low effectiveness and is limited by its toxicity. Developed in 1987 by James Cox surgical ablation of AF called MAZE procedure was very effective, but due to its invasiveness and complexity was not widely adopted. Landmark research done by Haissaguerre in 1998 initiated a new approach for treatment namely percutaneous catheter ablation, which remains a class I/A indication in symptomatic paroxysmal AF refractory to optimal medical therapy. However, its efficacy in patients with persistent atrial fibrillation (PSAF) is far from satisfactory. Recent advancements in devices and techniques of minimally invasive surgical ablation show very good results in the treatment of PSAF. Current guidelines equate surgical with catheter ablation within the scope of efficacy indicating that both may be considered as an effective and safe treatment option for patients with persistent forms of arrhythmia. The higher efficacy of surgical ablation was confirmed at a 7-year follow-up of FAST trial with recurrence rate as high as 87% in catheter arm compared with 56% in thoracoscopic ablation arm. A new concept of the invasive treatment of AF consisting of combined surgical (epicardial) and electrophysiological (endocardial) was introduced in 2009. Recently experts’ opinions and published data suggest that the proper hybrid treatment consisting of a planned combination of surgical and catheter ablation may give even better results. One of the most invaluable benefits of surgical ablations is the possibility of concomitant occlusion of the left atrial appendage. Recently good results have been reported for the novel epicardial clip for closing the left atrial appendage, which is placed in the deployment loop on a disposable holder. AME Publishing Company 2021-03 /pmc/articles/PMC8024848/ /pubmed/33841986 http://dx.doi.org/10.21037/jtd-20-1876 Text en 2021 Journal of Thoracic Disease. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) .
spellingShingle Review Article on Minimally Invasive Cardiac Surgery
Witkowska, Anna
Suwalski, Piotr
Insights from advancements and pathbreaking research on the minimally invasive treatment of atrial fibrillation
title Insights from advancements and pathbreaking research on the minimally invasive treatment of atrial fibrillation
title_full Insights from advancements and pathbreaking research on the minimally invasive treatment of atrial fibrillation
title_fullStr Insights from advancements and pathbreaking research on the minimally invasive treatment of atrial fibrillation
title_full_unstemmed Insights from advancements and pathbreaking research on the minimally invasive treatment of atrial fibrillation
title_short Insights from advancements and pathbreaking research on the minimally invasive treatment of atrial fibrillation
title_sort insights from advancements and pathbreaking research on the minimally invasive treatment of atrial fibrillation
topic Review Article on Minimally Invasive Cardiac Surgery
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8024848/
https://www.ncbi.nlm.nih.gov/pubmed/33841986
http://dx.doi.org/10.21037/jtd-20-1876
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