Download Free Medical RF Ablation of Atrial Fibrillation in Valvular Heart Surgery Patients PowerPoint Presentation

RF Ablation of Atrial Fibrillation in Valvular Heart Surgery Patients PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "RF Ablation of Atrial Fibrillation in Valvular Heart Surgery Patients" by Zeljko Sutlic.

This medical PowerPoint presentation talks about RF Ablation of Atrial Fibrillation in Valvular Heart Surgery Patients.

Radiofrequency (RF) ablation is a minimally invasive procedure that is commonly used to treat atrial fibrillation (AF), a condition characterized by an irregular and rapid heart rate. RF ablation works by using heat generated by high-frequency electromagnetic waves to destroy the heart tissue responsible for causing the abnormal heart rhythm.

Valvular heart surgery patients are at an increased risk of developing AF, and RF ablation is often used as a therapeutic option to treat AF in these patients. However, the success rate of RF ablation in valvular heart surgery patients can be lower than in patients without valvular heart disease, due to the underlying structural abnormalities of the heart and the higher prevalence of other comorbidities in these patients.

Tags : RF Ablation of Atrial Fibrillation, Valvular Heart Surgery, Radiofrequency ablation, atrial fibrillation, Cardiothoracic Surgery, cardiology, cardiology PowerPoint presentation

Published on : Mar 19, 2023 | Views : 1347 | Downloads : 0

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Slide 1-

RF Ablation of Atrial Fibrillation in Valvular Heart Surgery Patients Željko Sutlić
Slide 2-

Introduction The incidence of chronic atrial fibrilation (AF) is age dependent: 1% of the general population 4% in pts > 60 years 7% in pts > 70 years 60-80 % in pts with significant mitral valve disease
Slide 3-

AF - TYPES paroxsismal AF persistant AF permanent AF
Slide 4-

Criteria for Success Sinus Rhythm Absence of intermittent AF Absence of atrial flutter Atrial transport function Restricted antiarrhythmic medication
Slide 5-

Criteria Indication for mitral valve repair/replacement or coronary artery disease Chronic atrial fibrillation (>6 months) Electrocardiographical confirmation of diagnosed chronic atrial fibrillation by 24 hour holter monitoring EF > 30 % Age: 18 – 80 years Informed consent
Slide 6-

Atrial fibrillation in Patients Undergoing Mitral Valve Surgery: Why AF Surgery? Incidence of AF varies between 30 – 50% Curative AF surgery can eliminate the need for anticoagulation by restoring sinus rhythm, particulary important in patients having valve repair Rate of anticoagulation-related bleeding after mechanical valve surgery is between 0,3 to 4,9 events/ patient year Bleeding rates with mitral bioprosthesesare less but stillsignificant (0,6 – 2,1 episodes/patient year) in part due to the need for anticoagulation for AF
Slide 7-

Atrial Fibrillation: Surgical Therapy Cox developed the Maze Procedure – first performed in 1987 at Barnes Jewish Hospital High rate of surgical cure for atrial fibrillation (>90%) without antiarrhythmic therapy Indications: Drug refractory AF Arrhythmia intolerance Recurrent thromboembolism
Slide 8-

Atrial fibrillation and Mitral Valve Disease Should all patients with atrial fibrillation who are referred for mitral valve surgery undergo a concomitant Cox-Maze procedure? Let's look at our long term surgical results in these patients!
Slide 9-

Cox-Maze III Procedure Cox-Maze III first performed in 1988 Maze-like surgical incisions Based on theory of multiple macro-reentrant circuits
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The Cox Maze Procedure:Evolution of the Surgical Approach The Cox Maze I was abandoned because of a high incidence of chronotropic incompetence and pacemaker implantation The Cox Maze II was replaced because of its' technical difficulty The Cox Maze III has remained the gold standard since 1988 and has extraordinary long term efficacy
Slide 11-

The Cox-Maze Procedure:Surgical Objectives Cure of atrial fibrillation Restoration of A-V synchrony Preservation of atrial function Discontinuation of anticoagulation and anti-arrhythmic drugs
Slide 12-

Cox-Maze III ProcedurePatient Populations Lone atrial fibrillation Atrial fibrillation in association with organic heart disease: valvular heart disease ischemic heart disease
Slide 13-

Freedom form AF All Patients Cox JL. Surg Treat of AF, San Francisco, June 2003
Slide 14-

Freedom from AF LM versus CM Cox JL. Surg Treat of AF, San Francisco, June 2003
Slide 15-

Efficacy of Surgical Maze Procedure for Atrial Fibrillation
Slide 16-

Cox-Maze III Procedure with Mitral Surgery: Washington University Experience 65 consecutive patients between January 1988 – May 2003; mean follow-up = 3.6 years Avarage duration AF: 5.2 years (0,5–28 years) Paroxysmal AF: 41% Operative mortality : 1/65 ( 1.5% ) Freedom from AF at 10 years: 97% No late strokes!
Slide 17-

Advantages of the COX-MAZE III Procedure High cure rate (>90%) Proven long-term efficacy Applicable to both persistent and paroxysmal AF Eliminates the late risk of stroke in a high risk population Requires no additional devices except for a cryoprobe
Slide 18-

Shortcomings of the COX-MAZE III Procedure Requires cardiopulmonary bypass and an arrested heart Adds to cross-clamp time Few surgeons perform the operation due to its' complexity Significant morbidity pacemaker requirement and left atrial dysfunction
Slide 19-

Cox-Maze III Procedure for AF Postoperative Management Diuretics Lasix Spironolactone Coumadin 3 months Discontinue if in NSR Anti-arrhythmic drugs 2 months Discontinue if in NSR Postoperative sinus node dysfunction 10 – 15 % of patients Wait 7-10 days before implanting pacemaker
Slide 20-

The Cox Maze Procedure:Goals of a Less Invasive Approach Preserve the high success rates of the Cox-Maze III procedure while decreasing its' morbidity Simplify and/or decrease the number of atrial incisions to shorten the procedure and increase its' adoption rate among surgeons Replace surgical incisions with linear lines of ablation using various energy sources: Cryosurgery Radiofrequency Microwave Laser Ultrasound
Slide 21-

Radiofrequency energy similar to electrocautery very fast AC current no depolarisation of the heart monopolar or bipolar irrigated or not irrigated (early)
Slide 22-

Dry vs- Irrigated Electrode Tissue Heat Distribution
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Slide 24-

Complications of RF Ablation for Atrial Fibrillation CVA TIA Tamponade Aortic tear Pulmonary vein stenosis Damage to MV apparatus Phrenic nerve injury Coronary artery injury
Slide 25-

Surgical procedure (began on april 2003) MVR and TVP 6 patients MVR and CABG 1 patient average aortic clamp time 94 ± 42 min average pump time 124 ± 25 min
Slide 26-

Table 1. Clinical characteristics (n=7) 3/4
Slide 27-

Table 2. Echocardiographic variables
Slide 28-

Table 3. Single case (male, 58 years old, MVR + TVP)
Slide 29-

Surgery for Atrial Fibrillation:Established Facts and Surgical Approach We have very effective, though invasive, operation with high success rates Patients who are candidates for Cox Maze procedure should not be deprived of a curative, known procedure for a theoretical lesion set performed with unproven technology New procedures and technology should be subject to rigorous prospective clinical trials New lesion sets should be based on known mechanisms of atrial fibrillation
Slide 30-

Will There Be a Role for Surgery in the Future? Yes, for the symptomatic patient: Who requires other concomitant cardiac surgical procedures Coronary artery disease Valvular heart disease Congenital disease With prior thromboembolic complications For persistent and "permanent" atrial fibrillation Possibly With paroxysmal atrial fibrillation if performed via minimally invasive techniques
Slide 31-

Catheter Ablation Techniques for Atrial Fibrillation: Conclusions Effective (60-80%) for drug refractory paroxysmal AF with pulmonary vein triggers Targets PV-LA junction, with linear line to MVA, possible linear lesion across Bachman's bundle Prolonged procedures, requires transseptal access to the LA Lesions constrained by biophysical properties of tissue Complications approach 5% TIA/CVA Pulmonary vein stenosis Cardiac tamponade Aortic tear, coronary injury One of multiple tools available
Slide 32-

Everything should be made as simple as possible. But not simpler. Albert Einstein
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