A.S. Zhyhalkovich, R.R. Zhmailik, V.I. Sevrukevich
Purpose. To analyze long-term outcomes of minimally invasive epicardial video-assisted radiofrequency ablation (RFA) of the pulmonary veins (PV) and the posterior wall of the left atrium “box lesion” using Cobra technology in patients with various forms of isolated atrial fibrillation (AF).
Materials and methods. From September 2011 to November 2021, 85 patients (70 male, 15 female) suffering from various forms of idiopathic AF underwent surgery on the basis of the Republican Scientific and Practical Center of Cardiology, Republic of Belarus. The patients were operated on using epicardial video-assisted RFA of the PV and posterior wall of the left atrium “box lesion” using Cobra Adhere (45 patients) and Cobra Fusion (40 patients) devices. Mean age 53.8±8.80 years (28–71). History of AF – the burden of fibrillation before the surgery was 58.6±32.50 months. 35.3% (30 patients) had previously undergone ineffective PV catheter ablation.
Results. There were no lethal cases, as well as conversions to sternotomy, acute cerebrovascular accidents during the hospital period. The follow-up perio was studied in 100.0% of patients, the average follow-up period was 7.1+2.1 years. To evaluate the results, Holter monitoring was used after 3, 6, 12 months. after surgery, then annually, the readings of event monitors and the results of pacemaker programming. Positive results included sinus rhythm (SR) without AF/Atrial paroxysms for more than 30 s, as well as atrial (AAI) or dual-chamber DDD(R) pacing. The effectiveness of RFA of the PV and the posterior wall of the left atrium “box lesion” using Cobra Adhere and Cobra Fusion devices, depending on the initial type of AF in the long-term period (3 years), was: 56.3% /70.6% for paroxysmal AF, 28.0% / 44.4% for persistent AF, 0%/0% for long-standing persistent AF.
Conclusion. The Cobra technology proved to be the most effective in paroxysmal AF, less optimal results were obtained in persistent AF. In general, more consistent results were obtained with the Fusion technology. Efficacy also depended on the length of the follow-up, with the number of patients with sustained sinus rhythm decreasing over time and requiring additional catheter procedures in symptomatic patients.
keywords: atrial fibrillation, radiofrequency epicardial ablation, thoracoscopy.
for references: A.S. Zhyhalkovich, R.R. Zhmailik, V.I. Sevrukevich. long-term outcomes of minimally invasive epicardial video-assisted radio-frequency isolation of pulmonary veins and posterior wall of the left atrium “box lesion” in isolated atrial fibrillation using Cobra technology. Neotlozhnaya kardiologiya i kardiovaskulyarnye riski [Emergency cardiology and cardiovascular risks], 2023, vol. 7, no. 1, pp. 1776–1784.
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