Surgical Treatment of Lone Atrial Fibrillation in an Awake Patient

Authors

  • Gianluigi Bisleri
  • Tomaso Bottio
  • Aldo Manzato
  • Claudio Muneretto

DOI:

https://doi.org/10.1532/HSF98.20051006

Abstract

Surgical treatment of atrial fibrillation recently gained new popularity since the introduction of different energy sources and the development of minimally invasive techniques as an alternative to the original "cut-and-sew" technique. However, closed-chest ablation procedures are not feasible in presence of pericardial or pleural adhesions. To our knowledge, this is the first report of surgical treatment of atrial fibrillation in a conscious patient by means of a high epidural anesthesia. Since evidence of fibrothorax was found, a conscious patient suffering from lone atrial fibrillation underwent a beating-heart pulmonary veins isolation with a microwave device through a standard sternotomic approach. At 6 months follow-up, the patient is in stable sinus rhythm, without any palpitation nor electrocardiographic evidence (Holter monitoring) of recurrent atrial fibrillation.

References

Aybek T, Kessler P, Dogan S, et al. 2003. Awake coronary artery bypass grafting: utopia or reality? Ann Thorac Surg 75:1165-70.nBisleri G, Manzato A, Argenziano M, Vigilance DW, Muneretto C. 2005. Thoracoscopic epicardial pulmonary vein ablation for lone paroxysmal atrial fibrillation. Europace 7:145-8.nCox JL. 2003. Atrial fibrillation II: Rationale for surgical treatment. J Thorac Cardiovasc Surg 126:1693-9.nCox JL, Schuessler RB, Cain ME, et al. 1989. Surgery for atrial fibrillation. Semin Thorac Cardiovasc Surg 1:67-73.nKalil RAK, Lima GG, Leiria TLL, et al. 2002. Simple surgical isolation of pulmonary veins for treating secondary atrial fibrillation in mitral valve disease. Ann Thorac Surg 73:1169-73.nKaragoz HY, Kurtoglu M, Bakkaloglu B, Sonmez B, Cetintas T, Bayazit K. 2003. Coronary artery bypass grafting in the awake patient: three years' experience in 137 patients. J Thorac Cardiovasc Surg125:1401-4.nKottkamp H, Tanner H, Kobza R, et al. 2004. Time courses and quantitative analysis of atrial fibrillation episode number and duration after circular plus linear left atrial lesions. J Am Coll Cardiol 44:869 -77.nKnaut M, Tugtekin SM, Matschke K. 2004. Pulmonary vein isolation by microwave energy ablation in patients with permanent atrial fibrillation. J Card Surg 19:211-5.nLammers WJ, Schalij MJ, Kirchhof CJ, Allessie MA. 1990. Quantification of spatial inhomogeneity in conduction and initiation of reentrant atrial arrhythmias. Am J Physiol 259:H1254-63.nMaessen JG, Nijs JF, Smeets JL, Vainer J, Mochtar B. 2002. Beating-heart surgical treatment of atrial fibrillation with microwave ablation. Ann Thorac Surg 74:S1307-11.nPappone C, Rosanio S, Augello G, et al. 2003. Mortality, morbidity, and quality of life after circumferential pulmonary vein ablation for atrial fibrillation. J Am Coll Cardiol; 42:185-97.nPappone C, Rosanio S, Oreto G, et al. 2000. Circumferential radiofrequency ablation of pulmonary vein ostia: a new anatomic approach for curing atrial fibrillation. Circulation 102(21):2619-28.nSaltman AE, Rosenthal LS, Francalancia NA, Lahey SJ. 2003. A completely endoscopic approach to microwave ablation for atrial fibrillation. Heart Surg Forum 6(3):38-41.nAl-Saady NM, Obel OA, Camm AJ. 1999. Left atrial appendage: structure, function, and role in thromboembolism. Heart 82:547-55.nArgenziano M, Williams MR. 2003. Robotic atrial septal defect repair and endoscopic treatment of atrial fibrillation. Semin Thorac Cardiovasc Surg 15(2):130-40.nStollberger C, Schneider B, Finsterer J. 2003. Elimination of the left atrial appendage to prevent stroke or embolism? Chest 124:2356-62.nTodd DM, Skanes AC, Guiraudon G, et al. 2003. Role of the posterior left atrium and pulmonary veins in human lone atrial fibrillation. Circulation.108:3108-14.nWong T, Markides V, Peters NS, Davies DW. 2004. Percutaneous pulmonary vein cryoablation to treat atrial fibrillation. J Interv Card Electrophysiol 11:117-26.n

Published

2005-05-05

How to Cite

Bisleri, G., Bottio, T., Manzato, A., & Muneretto, C. (2005). Surgical Treatment of Lone Atrial Fibrillation in an Awake Patient. The Heart Surgery Forum, 8(3), E158-E160. https://doi.org/10.1532/HSF98.20051006

Issue

Section

Articles

Most read articles by the same author(s)