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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, Vol. 43, No. 10, 10.2020, p. 1115-1125.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Fink, T, Sciacca, V, Heeger, C-H, Vogler, J, Eitel, C, Reissmann, B, Rottner, L, Rillig, A, Mathew, S, Maurer, T, Ouyang, F, Kuck, K-H, Metzner, A & Tilz, RR 2020, 'Atrial fibrillation ablation in patients with pulmonary lobectomy or pneumectomy: Procedural challenges and efficacy', PACE, vol. 43, no. 10, pp. 1115-1125. https://doi.org/10.1111/pace.14041

APA

Fink, T., Sciacca, V., Heeger, C-H., Vogler, J., Eitel, C., Reissmann, B., Rottner, L., Rillig, A., Mathew, S., Maurer, T., Ouyang, F., Kuck, K-H., Metzner, A., & Tilz, R. R. (2020). Atrial fibrillation ablation in patients with pulmonary lobectomy or pneumectomy: Procedural challenges and efficacy. PACE, 43(10), 1115-1125. https://doi.org/10.1111/pace.14041

Vancouver

Fink T, Sciacca V, Heeger C-H, Vogler J, Eitel C, Reissmann B et al. Atrial fibrillation ablation in patients with pulmonary lobectomy or pneumectomy: Procedural challenges and efficacy. PACE. 2020 Oct;43(10):1115-1125. https://doi.org/10.1111/pace.14041

Bibtex

@article{9934131999d64c1bb0f053162623209f,
title = "Atrial fibrillation ablation in patients with pulmonary lobectomy or pneumectomy: Procedural challenges and efficacy",
abstract = "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.",
keywords = "Aged, Anticoagulants/administration & dosage, Atrial Fibrillation/diagnostic imaging, Catheter Ablation/instrumentation, Echocardiography, Transesophageal, Epicardial Mapping, Female, Germany, Humans, Male, Pneumonectomy, Pulmonary Veins/surgery, Retrospective Studies, Robotic Surgical Procedures/instrumentation",
author = "Thomas Fink and Vanessa Sciacca and Christian-Hendrik Heeger and Julia Vogler and Charlotte Eitel and Bruno Reissmann and Laura Rottner and Andreas Rillig and Shibu Mathew and Tilman Maurer and Feifan Ouyang and Karl-Heinz Kuck and Andreas Metzner and Tilz, {Roland Richard}",
note = "{\textcopyright} 2020 The Authors. Pacing and Clinical Electrophysiology published by Wiley Periodicals LLC.",
year = "2020",
month = oct,
doi = "10.1111/pace.14041",
language = "English",
volume = "43",
pages = "1115--1125",
journal = "PACE",
issn = "0147-8389",
publisher = "Wiley-Blackwell",
number = "10",

}

RIS

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 -