Minimally invasive surgery using bipolar radiofrequency energy is effective treatment for refractory atrial fibrillation

Vigneshwar Kasirajan, Elizabeth A. Spradlin, Tammy E. Mormando, Angel E. Medina, Phillip Ovadia, David S. Schwartzman, Thomas Gaines, Mubashir A. Mumtaz, Stephen W. Downing, Kenneth A. Ellenbogen

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: A web-based registry was used to prospectively study patients after minimally invasive surgery with monitoring to determine freedom from atrial fibrillation (AF) (clinicaltrials.gov/ct2/show/NCT00747838). This is a report showing the utility and feasibility of the registry. Methods: All patients had symptomatic AF refractory to medical treatment. Surgical ablation was performed using bipolar radiofrequency (RF) energy with a clamp around pulmonary veins and additional RF was delivered to ablate ganglionic plexi and create linear lesions. After a 3-month blanking period, prolonged electrocardiogram monitoring was done at 6 months, 1 year, and 2 years. Success was defined as no episodes of AF and atrial tachyarrhythmias greater than 30 seconds by monitoring. Results: A total of 118 patients were studied from 4 institutions from June 2006 to February 2011. Seventy-two patients were male (61%). The mean age was 64 ± 9 years. CHADS 2 (Congestive heart failure, Hypertension, age greater than 75, Diabetes and Stroke score for risk of thromboembolic events in patients with atrial fibrillation) was 1.3. Warfarin was used in 92 (78%), antiarrhythmic medications in 108 (92%), and 35 (30%) had previous catheter ablation. Paroxysmal AF was present in 80 (68%), persistent AF present in 35 (30%), and long-standing persistent present in 3 (2%). The mean left atrial size was 4.4 cm. The surgical approach was bilateral minithoracotomy in 69 (58%) and totally thoracoscopic in 49 (42%). The left atrial appendage was excluded or excised in 112 (95%) patients. There were no deaths related to the procedure. Only 5 (4%) patients required ventilation greater than 24 hours; permanent pacemaker was needed in 3 (2%) patients. Mean length of hospital stay was 5 days. At a mean follow-up of 16.5 months, 80% of patients were free of AF off antiarrhythmic medications with long-term monitoring. Quality of life data showed significant improvement at 6 and 12 months. Conclusions: The STAR (stable angina in practice) registry is an effective web-based tool for long-term follow-up of patients after surgery for AF. Minimally invasive surgery with lesions created by bipolar RF energy is an effective treatment for AF in carefully selected patients.

Original languageEnglish (US)
Pages (from-to)1456-1461
Number of pages6
JournalAnnals of Thoracic Surgery
Volume93
Issue number5
DOIs
StatePublished - May 1 2012

Fingerprint

Minimally Invasive Surgical Procedures
Atrial Fibrillation
Therapeutics
Registries
Length of Stay
Atrial Appendage
Stable Angina
Catheter Ablation
Pulmonary Veins
Warfarin
Tachycardia
Ventilation
Electrocardiography
Heart Failure
Stroke
Quality of Life
Hypertension

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Kasirajan, V., Spradlin, E. A., Mormando, T. E., Medina, A. E., Ovadia, P., Schwartzman, D. S., ... Ellenbogen, K. A. (2012). Minimally invasive surgery using bipolar radiofrequency energy is effective treatment for refractory atrial fibrillation. Annals of Thoracic Surgery, 93(5), 1456-1461. https://doi.org/10.1016/j.athoracsur.2012.01.110

Minimally invasive surgery using bipolar radiofrequency energy is effective treatment for refractory atrial fibrillation. / Kasirajan, Vigneshwar; Spradlin, Elizabeth A.; Mormando, Tammy E.; Medina, Angel E.; Ovadia, Phillip; Schwartzman, David S.; Gaines, Thomas; Mumtaz, Mubashir A.; Downing, Stephen W.; Ellenbogen, Kenneth A.

In: Annals of Thoracic Surgery, Vol. 93, No. 5, 01.05.2012, p. 1456-1461.

Research output: Contribution to journalArticle

Kasirajan, V, Spradlin, EA, Mormando, TE, Medina, AE, Ovadia, P, Schwartzman, DS, Gaines, T, Mumtaz, MA, Downing, SW & Ellenbogen, KA 2012, 'Minimally invasive surgery using bipolar radiofrequency energy is effective treatment for refractory atrial fibrillation', Annals of Thoracic Surgery, vol. 93, no. 5, pp. 1456-1461. https://doi.org/10.1016/j.athoracsur.2012.01.110
Kasirajan, Vigneshwar ; Spradlin, Elizabeth A. ; Mormando, Tammy E. ; Medina, Angel E. ; Ovadia, Phillip ; Schwartzman, David S. ; Gaines, Thomas ; Mumtaz, Mubashir A. ; Downing, Stephen W. ; Ellenbogen, Kenneth A. / Minimally invasive surgery using bipolar radiofrequency energy is effective treatment for refractory atrial fibrillation. In: Annals of Thoracic Surgery. 2012 ; Vol. 93, No. 5. pp. 1456-1461.
@article{fc5da54489094da2b27b1df7fa20023e,
title = "Minimally invasive surgery using bipolar radiofrequency energy is effective treatment for refractory atrial fibrillation",
abstract = "Background: A web-based registry was used to prospectively study patients after minimally invasive surgery with monitoring to determine freedom from atrial fibrillation (AF) (clinicaltrials.gov/ct2/show/NCT00747838). This is a report showing the utility and feasibility of the registry. Methods: All patients had symptomatic AF refractory to medical treatment. Surgical ablation was performed using bipolar radiofrequency (RF) energy with a clamp around pulmonary veins and additional RF was delivered to ablate ganglionic plexi and create linear lesions. After a 3-month blanking period, prolonged electrocardiogram monitoring was done at 6 months, 1 year, and 2 years. Success was defined as no episodes of AF and atrial tachyarrhythmias greater than 30 seconds by monitoring. Results: A total of 118 patients were studied from 4 institutions from June 2006 to February 2011. Seventy-two patients were male (61{\%}). The mean age was 64 ± 9 years. CHADS 2 (Congestive heart failure, Hypertension, age greater than 75, Diabetes and Stroke score for risk of thromboembolic events in patients with atrial fibrillation) was 1.3. Warfarin was used in 92 (78{\%}), antiarrhythmic medications in 108 (92{\%}), and 35 (30{\%}) had previous catheter ablation. Paroxysmal AF was present in 80 (68{\%}), persistent AF present in 35 (30{\%}), and long-standing persistent present in 3 (2{\%}). The mean left atrial size was 4.4 cm. The surgical approach was bilateral minithoracotomy in 69 (58{\%}) and totally thoracoscopic in 49 (42{\%}). The left atrial appendage was excluded or excised in 112 (95{\%}) patients. There were no deaths related to the procedure. Only 5 (4{\%}) patients required ventilation greater than 24 hours; permanent pacemaker was needed in 3 (2{\%}) patients. Mean length of hospital stay was 5 days. At a mean follow-up of 16.5 months, 80{\%} of patients were free of AF off antiarrhythmic medications with long-term monitoring. Quality of life data showed significant improvement at 6 and 12 months. Conclusions: The STAR (stable angina in practice) registry is an effective web-based tool for long-term follow-up of patients after surgery for AF. Minimally invasive surgery with lesions created by bipolar RF energy is an effective treatment for AF in carefully selected patients.",
author = "Vigneshwar Kasirajan and Spradlin, {Elizabeth A.} and Mormando, {Tammy E.} and Medina, {Angel E.} and Phillip Ovadia and Schwartzman, {David S.} and Thomas Gaines and Mumtaz, {Mubashir A.} and Downing, {Stephen W.} and Ellenbogen, {Kenneth A.}",
year = "2012",
month = "5",
day = "1",
doi = "10.1016/j.athoracsur.2012.01.110",
language = "English (US)",
volume = "93",
pages = "1456--1461",
journal = "Annals of Thoracic Surgery",
issn = "0003-4975",
publisher = "Elsevier USA",
number = "5",

}

TY - JOUR

T1 - Minimally invasive surgery using bipolar radiofrequency energy is effective treatment for refractory atrial fibrillation

AU - Kasirajan, Vigneshwar

AU - Spradlin, Elizabeth A.

AU - Mormando, Tammy E.

AU - Medina, Angel E.

AU - Ovadia, Phillip

AU - Schwartzman, David S.

AU - Gaines, Thomas

AU - Mumtaz, Mubashir A.

AU - Downing, Stephen W.

AU - Ellenbogen, Kenneth A.

PY - 2012/5/1

Y1 - 2012/5/1

N2 - Background: A web-based registry was used to prospectively study patients after minimally invasive surgery with monitoring to determine freedom from atrial fibrillation (AF) (clinicaltrials.gov/ct2/show/NCT00747838). This is a report showing the utility and feasibility of the registry. Methods: All patients had symptomatic AF refractory to medical treatment. Surgical ablation was performed using bipolar radiofrequency (RF) energy with a clamp around pulmonary veins and additional RF was delivered to ablate ganglionic plexi and create linear lesions. After a 3-month blanking period, prolonged electrocardiogram monitoring was done at 6 months, 1 year, and 2 years. Success was defined as no episodes of AF and atrial tachyarrhythmias greater than 30 seconds by monitoring. Results: A total of 118 patients were studied from 4 institutions from June 2006 to February 2011. Seventy-two patients were male (61%). The mean age was 64 ± 9 years. CHADS 2 (Congestive heart failure, Hypertension, age greater than 75, Diabetes and Stroke score for risk of thromboembolic events in patients with atrial fibrillation) was 1.3. Warfarin was used in 92 (78%), antiarrhythmic medications in 108 (92%), and 35 (30%) had previous catheter ablation. Paroxysmal AF was present in 80 (68%), persistent AF present in 35 (30%), and long-standing persistent present in 3 (2%). The mean left atrial size was 4.4 cm. The surgical approach was bilateral minithoracotomy in 69 (58%) and totally thoracoscopic in 49 (42%). The left atrial appendage was excluded or excised in 112 (95%) patients. There were no deaths related to the procedure. Only 5 (4%) patients required ventilation greater than 24 hours; permanent pacemaker was needed in 3 (2%) patients. Mean length of hospital stay was 5 days. At a mean follow-up of 16.5 months, 80% of patients were free of AF off antiarrhythmic medications with long-term monitoring. Quality of life data showed significant improvement at 6 and 12 months. Conclusions: The STAR (stable angina in practice) registry is an effective web-based tool for long-term follow-up of patients after surgery for AF. Minimally invasive surgery with lesions created by bipolar RF energy is an effective treatment for AF in carefully selected patients.

AB - Background: A web-based registry was used to prospectively study patients after minimally invasive surgery with monitoring to determine freedom from atrial fibrillation (AF) (clinicaltrials.gov/ct2/show/NCT00747838). This is a report showing the utility and feasibility of the registry. Methods: All patients had symptomatic AF refractory to medical treatment. Surgical ablation was performed using bipolar radiofrequency (RF) energy with a clamp around pulmonary veins and additional RF was delivered to ablate ganglionic plexi and create linear lesions. After a 3-month blanking period, prolonged electrocardiogram monitoring was done at 6 months, 1 year, and 2 years. Success was defined as no episodes of AF and atrial tachyarrhythmias greater than 30 seconds by monitoring. Results: A total of 118 patients were studied from 4 institutions from June 2006 to February 2011. Seventy-two patients were male (61%). The mean age was 64 ± 9 years. CHADS 2 (Congestive heart failure, Hypertension, age greater than 75, Diabetes and Stroke score for risk of thromboembolic events in patients with atrial fibrillation) was 1.3. Warfarin was used in 92 (78%), antiarrhythmic medications in 108 (92%), and 35 (30%) had previous catheter ablation. Paroxysmal AF was present in 80 (68%), persistent AF present in 35 (30%), and long-standing persistent present in 3 (2%). The mean left atrial size was 4.4 cm. The surgical approach was bilateral minithoracotomy in 69 (58%) and totally thoracoscopic in 49 (42%). The left atrial appendage was excluded or excised in 112 (95%) patients. There were no deaths related to the procedure. Only 5 (4%) patients required ventilation greater than 24 hours; permanent pacemaker was needed in 3 (2%) patients. Mean length of hospital stay was 5 days. At a mean follow-up of 16.5 months, 80% of patients were free of AF off antiarrhythmic medications with long-term monitoring. Quality of life data showed significant improvement at 6 and 12 months. Conclusions: The STAR (stable angina in practice) registry is an effective web-based tool for long-term follow-up of patients after surgery for AF. Minimally invasive surgery with lesions created by bipolar RF energy is an effective treatment for AF in carefully selected patients.

UR - http://www.scopus.com/inward/record.url?scp=84860255067&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84860255067&partnerID=8YFLogxK

U2 - 10.1016/j.athoracsur.2012.01.110

DO - 10.1016/j.athoracsur.2012.01.110

M3 - Article

VL - 93

SP - 1456

EP - 1461

JO - Annals of Thoracic Surgery

JF - Annals of Thoracic Surgery

SN - 0003-4975

IS - 5

ER -