Short-term results of two strategies in thoracoscopic ablation for lone atrial fibrillation

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Abstract

Background: Thoracoscopic ablation is an effective treatment of patients with atrial fibrillation. Nowadays, 2 types of ablative devices are available in clinical practice allowing one to perform the thoracoscopic procedure — Medtronic and AtriCure. However, the contemporary clinical literature does not have enough data that would compare these two approaches. Aims: to perform a comparative analysis of the short-term results of two minimally invasive strategies in thoracoscopic ablation for atrial fibrillation. Methods: 232 patients underwent thoracoscopic ablation for atrial fibrillation in two clinical centers for the period from 2016 to August 2021. The patients were divided into 2 groups. The first group was represented by those patients to whom a Medtronic device was applied (n=140), the second group was treated with an AtriCure device (n=92). The patients were comparable in their age, gender, initial severity of the condition. The follow-up consisted of laboratory tests, chest Х-ray, electrocardiography, 24-hour Holter monitor, echocardiography. The structure and prevalence of postoperative and intraoperative complications, specifics of the postoperative period were compared between the two groups. Results: According to the structure and prevalence of intraoperative complications the 2 groups are comparable to each other: 4.3% and 1.1% for the 1st group and 2nd group, respectively (p >0.05). The postoperative complications had developed in 6 (4.3%) and 5 (5.4%) patients in groups 1 and 2, respectively (p >0.05). At the time of discharge from hospital, a sinus rhythm was registered in 93.6% of patients (1st group), and 85.9% (2nd group) (p <0.05). Conclusions: Both strategies have demonstrated comparable short-term results in patients with lone atrial fibrillation. A further research is needed to evaluate the effectiveness of this strategy in a long-term period.

About the authors

Aleksandr S. Zotov

Federal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency

Email: zotov.alex.az@gmail.com
ORCID iD: 0000-0003-0494-0211
SPIN-code: 9315-6570

MD, PhD

Russian Federation, 28, Orekhovy blvd, Moscow, 115682

Oleg Yu. Pidanov

Clinical City Hospital named after I.V. Davydovsky

Email: 9681@mail.ru
ORCID iD: 0000-0003-2017-9258
SPIN-code: 8264-7791

MD, PhD

Russian Federation, 28, Orekhovy blvd, Moscow, 115682

Ilkin S. Osmanov

Federal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency

Email: dr.osmanov@bk.ru
ORCID iD: 0000-0002-8114-529X
SPIN-code: 9214-2606
ResearcherId: GQP-0474-2022

MD

Russian Federation, 28, Orekhovy blvd, Moscow, 115682

Aleksandr V. Troitskiy

Federal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency

Email: dr.troitskiy@gmail.com
ORCID iD: 0000-0003-2143-8696
SPIN-code: 2670-6662

MD, PhD

Russian Federation, 28, Orekhovy blvd, Moscow, 115682

Aleksandr A. Silayev

Federal State Budget Institution Clinical hospital

Email: Surgeon-Alex@yandex.ru
ORCID iD: 0000-0002-3798-1936

MD, PhD

Russian Federation, 28, Orekhovy blvd, Moscow, 115682

Emil' R. Sakharov

Federal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency

Email: sakharoom@gmail.com
ORCID iD: 0000-0003-1057-2777
SPIN-code: 6744-9462

MD

Russian Federation, 28, Orekhovy blvd, Moscow, 115682

Vladimir N. Sukhotin

Federal State Budget Institution Clinical hospital

Email: vladimir.suhotin@yandex.ru
ORCID iD: 0000-0001-6897-4483

MD

Russian Federation, 28, Orekhovy blvd, Moscow, 115682

Oleg O. Shelest

Federal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency

Email: toshelest@gmail.com
ORCID iD: 0000-0002-0087-9049

MD

Russian Federation, 28, Orekhovy blvd, Moscow, 115682

Robert I. Khabazov

Federal Scientific and Clinical Center for Specialized Medical Assistance and Medical Technologies of the Federal Medical Biological Agency

Email: khabazov119@gmail.com
ORCID iD: 0000-0001-6801-6568

MD, PhD

Russian Federation, 28, Orekhovy blvd, Moscow, 115682

Denis A. Timashkov

Federal State Budget Institution Clinical hospital

Author for correspondence.
Email: denistima@gmail.com
ORCID iD: 0000-0003-2831-1284

MD

Russian Federation, 28, Orekhovy blvd, Moscow, 115682

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Supplementary files

Supplementary Files
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2. Fig. 1. Medtronic equipment: а — bipolar ablative device (clamping-electrode) Medtronic Cardioblate Gemini-S; б — cardioblate Generator 68000 RF generator.

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3. Fig. 2. AtriCure equipment: а — bipolar clamping-electrode Isolator EMR2, right; б — bipolar clamping-electrode Isolator EML2, left; в — electrode for linear ablation MLP1; г — radio frequency generator AtriCure.

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4. Fig. 3. Pattern of isolation of the antrum of the pulmonary veins and the posterior wall of the left atrium using Medtronic equipment (а) and AtriCure (б).

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5. Fig. 4. Positioning of the stapler during resection of the left atrium appendage.

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6. Fig. 5. Operative time and time of ablation time in the studied groups (p <0,05).

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Copyright (c) 2022 Zotov A.S., Pidanov O.Y., Osmanov I.S., Troitskiy A.V., Silayev A.A., Sakharov E.R., Sukhotin V.N., Shelest O.O., Khabazov R.I., Timashkov D.A.

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