Atrial fibrillation ablation in patients with pulmonary lobectomy or pneumectomy: Procedural challenges and efficacy
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Atrial fibrillation ablation in patients with pulmonary lobectomy or pneumectomy: Procedural challenges and efficacy. / Fink, Thomas; Sciacca, Vanessa; Heeger, Christian-Hendrik; Vogler, Julia; Eitel, Charlotte; Reissmann, Bruno; Rottner, Laura; Rillig, Andreas; Mathew, Shibu; Maurer, Tilman; Ouyang, Feifan; Kuck, Karl-Heinz; Metzner, Andreas; Tilz, Roland Richard.
in: PACE, Jahrgang 43, Nr. 10, 10.2020, S. 1115-1125.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Atrial fibrillation ablation in patients with pulmonary lobectomy or pneumectomy: Procedural challenges and efficacy
AU - Fink, Thomas
AU - Sciacca, Vanessa
AU - Heeger, Christian-Hendrik
AU - Vogler, Julia
AU - Eitel, Charlotte
AU - Reissmann, Bruno
AU - Rottner, Laura
AU - Rillig, Andreas
AU - Mathew, Shibu
AU - Maurer, Tilman
AU - Ouyang, Feifan
AU - Kuck, Karl-Heinz
AU - Metzner, Andreas
AU - Tilz, Roland Richard
N1 - © 2020 The Authors. Pacing and Clinical Electrophysiology published by Wiley Periodicals LLC.
PY - 2020/10
Y1 - 2020/10
N2 - BACKGROUND: Catheter ablation of atrial fibrillation (AF) in patients with pulmonary lobectomy or pneumectomy is challenging due to anatomical alterations. After lung resection, electrically active pulmonary vein (PV) stumps remain and need to be localized for PV isolation (PVI). The present study aims to describe clinical challenges of PVI in patients with pulmonary lobectomy or pneumectomy.METHODS: We performed a retrospective study on 19 patients with previous pulmonary lobectomy or pneumectomy undergoing catheter ablation for AF in three German hospitals.RESULTS: Nineteen patients with paroxysmal, persistent, or longstanding-persistent AF and history of pulmonary lobectomy (n = 11) or pneumectomy (n = 8) were enrolled. Catheter ablation was performed as radiofrequency (RF) ablation using 3D mapping, robotic RF ablation, or by using balloon devices. Decent anatomical changes were observed in patients with lobectomy while cardiac rotation and mediastinal shifting was dominant in patients with pneumectomy. Visualization of all PVs including PV stumps by PV angiography was possible in 10 of 19 patients (52.6%). PV spikes were observed in all identified PV remnants. In nine patients (47.4%), at least one PV remnant could not be identified and electrical isolation was not performed. During 24 months follow-up, patients with incomplete PVI had a significantly shorter arrhythmia-free survival than patients with complete PVI (76.2% [95% Confidence interval (CI) 47.2-100.0%] vs 40.0% [95% CI 5.6-74.1%], P = .043).CONCLUSION: In patients with AF and previous lobectomy or pneumectomy, identification and isolation of all PVs are challenging but crucial for ablation success. Additional imaging techniques may be necessary to achieve complete PVI.
AB - BACKGROUND: Catheter ablation of atrial fibrillation (AF) in patients with pulmonary lobectomy or pneumectomy is challenging due to anatomical alterations. After lung resection, electrically active pulmonary vein (PV) stumps remain and need to be localized for PV isolation (PVI). The present study aims to describe clinical challenges of PVI in patients with pulmonary lobectomy or pneumectomy.METHODS: We performed a retrospective study on 19 patients with previous pulmonary lobectomy or pneumectomy undergoing catheter ablation for AF in three German hospitals.RESULTS: Nineteen patients with paroxysmal, persistent, or longstanding-persistent AF and history of pulmonary lobectomy (n = 11) or pneumectomy (n = 8) were enrolled. Catheter ablation was performed as radiofrequency (RF) ablation using 3D mapping, robotic RF ablation, or by using balloon devices. Decent anatomical changes were observed in patients with lobectomy while cardiac rotation and mediastinal shifting was dominant in patients with pneumectomy. Visualization of all PVs including PV stumps by PV angiography was possible in 10 of 19 patients (52.6%). PV spikes were observed in all identified PV remnants. In nine patients (47.4%), at least one PV remnant could not be identified and electrical isolation was not performed. During 24 months follow-up, patients with incomplete PVI had a significantly shorter arrhythmia-free survival than patients with complete PVI (76.2% [95% Confidence interval (CI) 47.2-100.0%] vs 40.0% [95% CI 5.6-74.1%], P = .043).CONCLUSION: In patients with AF and previous lobectomy or pneumectomy, identification and isolation of all PVs are challenging but crucial for ablation success. Additional imaging techniques may be necessary to achieve complete PVI.
KW - Aged
KW - Anticoagulants/administration & dosage
KW - Atrial Fibrillation/diagnostic imaging
KW - Catheter Ablation/instrumentation
KW - Echocardiography, Transesophageal
KW - Epicardial Mapping
KW - Female
KW - Germany
KW - Humans
KW - Male
KW - Pneumonectomy
KW - Pulmonary Veins/surgery
KW - Retrospective Studies
KW - Robotic Surgical Procedures/instrumentation
U2 - 10.1111/pace.14041
DO - 10.1111/pace.14041
M3 - SCORING: Journal article
C2 - 32794580
VL - 43
SP - 1115
EP - 1125
JO - PACE
JF - PACE
SN - 0147-8389
IS - 10
ER -