Novel Technique for Box-Lesion Ablation of Atrial Fibrillation Combined with Off-Pump Coronary Surgery

ABSTRACT Introduction: We propose a new technique for box-lesion ablation combined with off-pump coronary artery bypass grafting for the treatment of patients with coronary artery disease and paroxysmal or persistent atrial fibrillation. Methods: Eight male patients with paroxysmal (n=2) or persistent atrial fibrillation (n=6) and coronary artery disease underwent box-lesion ablation combined with off-pump coronary artery bypass grafting. Box-lesion ablation was performed using a bipolar flexible clamping device with irrigated electrodes which was originally designed for thoracoscopic epicardial ablation. Results: Complete revascularization was performed in all patients. There were no deaths or major complications. At a median follow-up of 14 months, seven patients (87.5%) were in sinus rhythm. Conclusion: Box-lesion ablation can be easily and effectively combined with coronary artery surgery in an off-pump setting.

Simultaneous thoracoscopic approach in a patient with long-standing persistent atrial fibrillation and primary lung cancer: the first described case

Abstract Cardiac rhythm disorders are common in many patients with cancer. The management of synchronous long-standing persistent atrial fibrillation and pulmonary lesions remains a serious surgical dilemma due to the lack of clinical data and surgical guidelines. To the best of our knowledge, this is the first described case of simultaneous thoracoscopic pulmonary segmentectomy and left atrial posterior wall and pulmonary vein isolation combined with left atrial appendage resection in a patient with early-stage primary lung cancer and long-standing persistent atrial fibrillation.

Thoracoscopic pulmonary vein and left atrial posterior wall isolation combined with left atrial appendage resection in patients with long-standing persistent atrial fibrillation

Abstract Objective: To evaluate the efficacy and safety of a modified technique for totally thoracoscopic left atrial posterior wall and pulmonary vein isolation in patients with long-standing persistent atrial fibrillation. Methods: From April 2017 to December 2018, we included in this study 28 consecutive patients who underwent thoracoscopic left atrial posterior wall and pulmonary vein radiofrequency isolation combined with left atrial appendage resection. We used a device with irrigated electrodes (Medtronic Cardioblate Gemini-s). The original surgical technique "GALAXY" proposed by Doty in 2012 was modified. The number of ablations was significantly increased, and frequent position changing of the ablation device and change of device angulation were added. Results: Sinus rhythm was restored in all patients. There was no operative mortality, no myocardial infarction, and no stroke or transient ischemic attack. One patient required sternotomy and another survived left anterolateral thoracotomy due to bleeding. A 180-day follow-up (24-hour Holter monitoring) revealed no sign of recurrence of atrial fibrillation or other supraventricular arrhythmia in any patient. Mean follow-up was nine months (range: 6-16 months). At the last follow-up, 26 patients (92,9%) were in sinus rhythm (24-hour Holter monitoring). Conclusion: A frequent ablation device position changing during the surgery makes it possible to achieve complete left atrial posterior wall and pulmonary veins isolation. An increased number of applications allows to avoid a false positive transmural damage assessment showed by impedance drop. Also, frequent position changing of the ablation device and increased number of applications do not affect the number of postoperative complications.

Erythropoietin Improves Effects of Mesenchymal Stem Cells in Experimental Endotoxemia.

Aims: Sepsis is a leading cause of mortality in intensive care units. Development of new strategies such as the therapy with mesenchymal stem cells (MSC) appears beneficial for the treatment of sepsis. In this study we evaluated anti-septic effects of rat MSCs and recombinant erythropoietin (EPO) in a rat experimental model of endotoxemia. Study Design: Controlled in vitro and in vivo studies. Place and Duration of Study: Federal Research Clinical Center of FMBA of Russia, Moscow, Russia, between June 2014 and May 2015. Methodology: Endotoxemia was induced by intraperitoneal administration of bacterial lipopolysacharide (LPS). The animals were then treated either with allogeneic MSCs alone, with recombinant EPO alone, or with a combination of EPO and MCS. After 3 days , the animals were euthanized, and a pathology study of their liver, spleen, thymus, lung, and kidney was performed. The serum levels of IL-1β, IL-6, and TNF-α were quantified. A histochemical analysis of splenic and thymic expression of CD3, CD57, p53, and Bcl-2 was performed. Results: Essential positive effects of the combined MSC-EPO treatment were observed: 1) The animals treated with MSCs and EPO had the lowest serum concentrations of IL-1β in respect to that of the rats treated with LPS alone (58 ± 22 pg/mL vs. 155±90 pg/mL, P = .01); 2) The treatment of endotoxemic rats with a combination of MSCs and EPO also caused production of the anti-apoptotic factor Bcl-2, while its expression was markedly down-regulated in the other groups of animals; 3) In the MSC + EPO group, the degree of interstitial pulmonary edema was the lowest as compared to the other groups, and a minimal renal injury was detected . Conclusion: These findings suggest that EPO generally improves anti-inflammatory and anti-apoptotic effects of MSCs injected in the acute phase of experimental endotoxemia.