دورية أكاديمية
Additional Ganglion Plexus Ablation During Thoracoscopic Surgical Ablation of Advanced Atrial Fibrillation: Intermediate Follow-Up of the AFACT Study.
| العنوان: | Additional Ganglion Plexus Ablation During Thoracoscopic Surgical Ablation of Advanced Atrial Fibrillation: Intermediate Follow-Up of the AFACT Study. |
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| المؤلفون: | Berger WR; Department of Cardiology, Heart Center, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Cardiology, Heart Center, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands., Neefs J; Department of Cardiology, Heart Center, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands., van den Berg NWE; Department of Cardiology, Heart Center, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands., Krul SPJ; Department of Cardiology, Heart Center, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands., van Praag EM; Department of Cardiology, Heart Center, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands., Piersma FR; Department of Cardiology, Heart Center, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands., de Jong JSSG; Department of Cardiology, Heart Center, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands., van Boven WP; Department of Cardiothoracic Surgery, Heart Center, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands., Driessen AHG; Department of Cardiothoracic Surgery, Heart Center, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands., de Groot JR; Department of Cardiology, Heart Center, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands. Electronic address: j.r.degroot@amc.uva.nl. |
| المصدر: | JACC. Clinical electrophysiology [JACC Clin Electrophysiol] 2019 Mar; Vol. 5 (3), pp. 343-353. Date of Electronic Publication: 2018 Nov 28. |
| نوع المنشور: | Journal Article; Research Support, Non-U.S. Gov't |
| اللغة: | English |
| بيانات الدورية: | Publisher: Elsevier Inc Country of Publication: United States NLM ID: 101656995 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2405-5018 (Electronic) Linking ISSN: 2405500X NLM ISO Abbreviation: JACC Clin Electrophysiol Subsets: MEDLINE |
| أسماء مطبوعة: | Original Publication: [New York, NY] : Elsevier Inc., [2015]- |
| مواضيع طبية MeSH: | Catheter Ablation*/adverse effects , Catheter Ablation*/methods , Catheter Ablation*/statistics & numerical data , Thoracoscopy*/adverse effects , Thoracoscopy*/methods , Thoracoscopy*/statistics & numerical data, Atrial Fibrillation/*surgery, Aged ; Anti-Arrhythmia Agents/therapeutic use ; Atrial Fibrillation/drug therapy ; Female ; Follow-Up Studies ; Heart Atria/physiopathology ; Heart Atria/surgery ; Humans ; Male ; Middle Aged ; Recurrence ; Treatment Outcome |
| مستخلص: | Objectives: The authors report the 2-year follow-up results of the AFACT (Atrial Fibrillation Ablation and Autonomic Modulation via Thoracoscopic Surgery) study. Background: The AFACT study randomized patients with advanced atrial fibrillation (AF) to thoracoscopic AF ablation with or without additional ganglion plexus (GP) ablation. At 1 year, there was no difference in AF freedom between the groups, but autonomic modification may exert beneficial effects during longer follow-up. Methods: Patients underwent thoracoscopic pulmonary vein isolation, with additional left atrial lines in persistent AF patients, and were randomized 1:1 to ablation of the 4 major GP and Marshall ligament or no GP ablation (control). Patients were followed every 3 months up to 18 months and at 24 months. After an initial 3-month blanking period, all antiarrhythmic drugs were discontinued. Results: The authors randomized 240 patients (age 59 ± 8 years, 73% men, 68% enlarged left atrium, 60% persistent AF), of whom 228 patients (95%) completed follow-up. Freedom of any atrial tachyarrhythmia did not differ significantly between the GP group (55.6%) and control group (56.1%) (p = 0.91), with no difference in paroxysmal (p = 0.60) or persistent AF patients (p = 0.88). Documented AF recurrences were similar between treatment arms: 11.8% (GP) versus 11.0% (control) had >3 recurrences/year (p = 0.82). More persistent AF patients (17.0%) than paroxysmal (3.2%) had >3 recurrences per year (p < 0.01). Despite this, 78% of patients were off antiarrhythmic drugs after 2 years. No procedural-related complications occurred in the second year. Conclusions: Additional GP ablation during thoracoscopic surgery for advanced AF does not affect freedom of AF recurrence. As GP ablation is associated with more major procedural complications, it should not routinely be performed. (Atrial Fibrillation Ablation and Autonomic Modulation via Thorascopic Surgery [AFACT]; NCT01091389). (Copyright © 2019 The Authors. Published by Elsevier Inc. All rights reserved.) |
| فهرسة مساهمة: | Keywords: atrial arrhythmia; autonomic nervous system; pulmonary vein isolation; surgical ablation |
| سلسلة جزيئية: | ClinicalTrials.gov NCT01091389 |
| المشرفين على المادة: | 0 (Anti-Arrhythmia Agents) |
| تواريخ الأحداث: | Date Created: 20190323 Date Completed: 20200402 Latest Revision: 20200402 |
| رمز التحديث: | 20231215 |
| DOI: | 10.1016/j.jacep.2018.10.008 |
| PMID: | 30898238 |
| قاعدة البيانات: | MEDLINE |
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Full Text Finder | تدمد: | 2405-5018 |
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| DOI: | 10.1016/j.jacep.2018.10.008 |