Studio Medico Nasso De Rosis Congressi ed Eventi, Generale, Rassegna Stampa Dr. Nasso, Scoperte scientifiche

The fate of patients after failed epicardial ablation of atrial fibrillation

Much debate is still going on about the best ablation strategy—via endocardial or epicardial approach—in patients with atrial fibrillation (AF), and evidence gaps exist in current guidelines in this area. More specifically, there are no clear long-term outcome data after failed surgical AF ablation.

Background: Much debate is still going on about the best ablation strategy—via endocardial or epicardial approach—in patients with atrial fbrillation (AF), and evidence gaps exist in current guidelines in this area. More specifcally, there are no clear long-term outcome data after failed surgical AF ablation.
Methods: Since June 2008, 549 surgical AF ablation procedures through a right minithoracotomy were performed at our institution. From 2008 to 2011, a unipolar radiofrequency device was used (151 patients), whereas from 2011 to 2020 a bipolar radiofrequency device was used (398 patients). Patients were scheduled for surgery on the basis of the following criteria: recurrent episodes of paroxysmal or persistent lone AF refractory to maximally tolerated antiarrhythmic drug dosing and at least one failed cardioversion attempt. Besides the recommended follow-up by the local
cardiologist, starting from 2021, surviving patients were asked to undergo assessment of left ventricular function and to complete a questionnaire addressing quality of life and predisposing factors for recurrent AF.
Results: At a mean follow-up of 77 months, the rate of AF recurrence was 20.7% (n=114). On multivariate analysis, impaired left ventricular ejection fraction (58 patients, 51%, p=0.002), worsening of European Heart Rhythm Association (EHRA) symptom class (37 patients, 32%, p=0.003) and cognitive decline or depression (23 patients, 20%, p=0.023) during follow-up were found to be signifcantly associated with AF recurrence.
Conclusions: Surgical AF ablation through a right minithoracotomy is safe, but a better outcome could be achieved using a hybrid approach. Patients after initial failed surgical AF ablation show worsening of cardiac function, clinical status and quality of life at follow-up compared to patients with successful AF ablation.
Keywords: Atrial fbrillation, Surgical ablation of atrial fbrillation, Catheter ablation of atrial fbrillation

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Studio Medico Nasso De Rosis Rassegna Stampa Dr. Nasso

Catheter, surgical, or hybrid procedure: what future for atrial fibrillation ablation?

Abstract

Background: The debate on the best treatment strategy for atrial fibrillation (AF) has expanded following the introduction of the so-called “hybrid procedure” that combines minimally invasive epicardial ablation with endocardial catheter ablation. However, the advantage of the hybrid approach over conventional epicardial ablation remains to be established.

Methods: From June 2008 to December 2020, 609 surgical AF ablation procedures through a right minithoracotomy were performed at our institution. From 2008 to 2011, a unipolar radiofrequency (RF) device was used, whereas from 2011 to 2020 a bipolar RF device was used. In addition, between September 2016 and April 2017, 60 patients underwent endocardial completion of epicardial linear ablation. In 30 of these latter patients, surgical isolation of the Bachmann’s bundle (BB) was also performed. Starting from 2021, surviving patients at follow-up were asked to undergo electrocardiographic evaluation and left ventricular function assessment and to complete a questionnaire addressing quality of life and predisposing factors for recurrent AF.

Results: The ablation procedure was completed in all patients. Upon discharge, 30 (4.9%) patients showed recurrence of AF, whereas the remaining patients (95.1%) were in sinus rhythm. All patients in whom a hybrid approach was used either with or without BB ablation were discharged in sinus rhythm. After a mean follow-up of 74 months, 122 (20%) patients developed recurrent AF, including 19.9% in whom a unipolar RF device was used, 21% in whom a bipolar RF device was used, 23% who had undergone a hybrid procedure without BB ablation and 3.3% who had undergone a hybrid procedure with BB ablation. On multivariate analysis, reduced left ventricular ejection fraction, worsening of European Heart Rhythm Association symptom class, and cognitive impairment or depression during follow-up were found to be significantly associated with AF recurrence.

Conclusions: Surgical AF ablation through a right minithoracotomy is safe and may allow the creation of additional linear lesions, particularly in the BB. The placement of adjunctive linear lesions in the setting of a hybrid procedure can be more effective in reducing the risk for AF recurrence than isolated surgical ablation or hybrid ablation without the addition of further linear lesions, with no incremental risk to the patient. 

Keywords: Surgical ablation of atrial fibrillation, Catheter ablation of atrial fibrillation, Hybrid ablation of atrial fibrillation

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Studio Medico Nasso De Rosis Generale

Apnee ostruttive del sonno: cosa sono? Quali sono le cause e come affrontare questo disturbo?

Respirare regolarmente durante il sonno è fondamentale per riuscire a dormire. Se il sonno si interrompe più volte nel corso della notte per problemi legati alla respirazione siamo di fronte a una patologia: le Apnee Ostruttive del Sonno. Come affrontare questo disturbo?
Ne parleremo con la pneumologa Maria Grazia De Rosis e la biologa nutrizionista Eleonora Vecchio

Studio Medico Nasso De Rosis Cardiochirurgia, Generale, Rassegna Stampa Dr. Nasso

«Promosso» il by-pass aorto coronarico con arteria radiale

Uno studio a dieci anni dai primi interventi conferma la validità della tecnica in alternativa all’utilizzo della vena grande safena

Il bypass aorto-coronarico è l’intervento che permette di «by-passare» cioè aggirare, un ostacolo presente in una delle piccole arterie che porta il sangue al muscolo cardiaco. L’operazione consiste nel creare una sorta di «ponte» che «scavalchi» l’ostruzione utilizzando un segmento di vaso prelevato da un’altra zona del corpo. Tradizionalmente viene usata la vena grande safena, presa dall’arto inferiore. Ora uno studio pubblicato su una rivista del gruppo Jama (Journal of American Medical Association) indica che l’utilizzo dell’arteria radiale, che scorre nel braccio, può presentare dei vantaggi. Lo studio riporta l’esperienza di specialisti in diversi centri internazionali, fra cui gli italiani Giuseppe Nasso, responsabile dell’unità operativa di Cardiochirurgia presso l’Anthea Hospital di Bari e Giuseppe Speziale responsabile delle cardiochirurgie di GVM Care & Research, accreditate con il Servizio Sanitario Nazionale. I primi risultati dopo un monitoraggio di 5 anni erano già stati pubblicati sul New England Journal of Medicine, quelli appena comunicati su Jama riferiscono i risultati a 10 anni dall’intervento. «Abbiamo concluso che questo approccio permette al paziente non solo di vivere meglio nel corso degli anni successivi, ma soprattutto di vivere più a lungo, questo perché si riduce l’incidenza di nuovi infarti e di essere sottoposto a nuove procedure di rivascolarizzazione miocardica» commenta Nasso. «L’arteria radiale, infatti, al contrario della vena safena, anche dopo tanto tempo rimane funzionante».
«Un paziente sottoposto ad intervento di bypass aortocoronarico è un paziente che di fatto ha risolto la problematica in essere, ma è doveroso seguirlo anche nel post-operatorio, spiegandogli che deve eliminare tutti i fattori di rischio che lo hanno portato alla malattia, che possono essere il fumo, la pressione arteriosa alta, una dieta con un elevato contenuto di grassi insaturi, o anche elevati valori di colesterolo e trigliceridi» sottolinea comunque Nasso. «Se non si eliminano questi fattori di rischio, qualsiasi bypass nel tempo non sarà sufficiente a risolvere la patologia coronarica ma ancora peggio si avrà una progressione della malattia sulle altre coronarie».

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