Effect of Left Atrial Appendage Excision on Procedure Outcome in Patients With Persistent and Long-standing Persistent Atrial Fibrillation Undergoing Surgical Ablation
Atrial Fibrillation
About this trial
This is an interventional treatment trial for Atrial Fibrillation focused on measuring atrial fibrillation, ablation, thoracoscopy, left atrial appendage
Eligibility Criteria
Key Inclusion Criteria:
- Patients with persistent and long-standing persistent atrial fibrillation eligible for thoracoscopy surgical ablation
- Signed inform consent
Key Exclusion Criteria:
- Paroxysmal atrial fibrillation
- Contraindications for surgical ablation
- Unwilling to participate
Sites / Locations
- Federal Center of Cardiovascular surgery
- Federal State Institution Clinical Hospital of the Presidental Administration of the RF
- Scientific center of the cardiovascular surgery named by A.N. Bakulev
- State Research Institute of CIrculation Pathology
Arms of the Study
Arm 1
Arm 2
Active Comparator
Experimental
PVI+Box lesions
PVI+Box lesions+LAA cutting
Patients were treated with video-assisted thoracoscopy under general anesthesia, according to a previously described protocol. In brief, PVI was performed from the epicardial side with a bipolar radiofrequency ablation clamp. At least 2 overlapping applications around each of the ipsilateral veins were made, and isolation was confirmed by the absence of PV potentials and exit block during pacing. In addition to PVI, the bilateral epicardial ganglia were found by high-frequency stimulation and ablated, as confirmed by the absence of a vagal response after ablation. Finally additional lines were made to create a posterior box lesion. Sensing and pacing maneuvers verified isolation of the posterior box.
Patients were treated with video-assisted thoracoscopy under general anesthesia, according to a previously described protocol. In brief, PVI was performed from the epicardial side with a bipolar radiofrequency ablation clamp. At least 2 overlapping applications around each of the ipsilateral veins were made, and isolation was confirmed by the absence of PV potentials and exit block during pacing. In addition to PVI, the bilateral epicardial ganglia were found by high-frequency stimulation and ablated, as confirmed by the absence of a vagal response after ablation. Finally additional lines were made to create a posterior box lesion. Sensing and pacing maneuvers verified isolation of the posterior box.The left atrial appendage was removed by stapling and then cutting.