EP Lab Digest - May 2008 - (Page 12)

12 COVER STORY MAY 2008 A HYBRID APPROACH TO THE CURE OF ATRIAL FIBRILLATION Continued from page 10 lateral decubitus position and the right chest was prepped and draped. Dr.Ailawadi made similar incisions on the right side. The phrenic nerve was identified and the pericardium was opened. The oblique sinus was opened, and the right superior pulmonary vein and right PA were separated under direct visualization. Dr. Mahapatra performed atrial mapping and stimulation, which revealed a positive response at ganglia R1, R3, R5, R7, and R9. A lighted dissector was again used to encircle the right-sided veins followed by the ablation clamp, creating four separate bipolar burns on the left atrium. A connecting lesion from the right side across the roof of the left atrium was performed with the pen. Using TEE guidance, an additional lesion was created with the pen to the mitral annulus. The GP were re-mapped; those found to be positive were ablated, and the right pulmonary veins were confirmed to have entrance block. At the conclusion of these ablations, the patient was in atrial flutter and was successfully cardioverted on the initial attempt into a sinus rhythm. An 8 mm chest tube was placed in the right side and skin was closed. Figure 2. After opening the pericardium, the left pulmonary veins are encircled with an AtriCure bipolar clamp to create full thickness radiofrequency lesions. The AtriCure pen on the right can sense and pace to confirm block and test for active GP. Post-Op The patient was admitted to the postoperative unit after the procedure and was extubated that day. On postoperative day 1, he began ambulating and was started on Toradol for pain control. IV fluids were discontinued and his diet was advanced. He was moved to a general care floor. By the third day, both chest tubes were removed. The chronicity of the patient’s AF led to the preoperative plan that the patient should undergo a percutaneous atrial flutter ablation procedure. On post-op day 4, the patient was brought to Dr. Mahapatra in the electrophysiology lab, where it was noted that the patient did not have block across his atrial flutter line. Thus, Dr. Mahapatra performed a repeat cavotricuspid isthmus line and and SVC isolation. Near the conclusion of the procedure, while isoproterenol at 20 micrograms was being infused and with aggressive pacing, AF was induced. The patient was cardioverted electrically and returned to a sinus rate of 60 bpm. He was restarted on warfarin and amiodarone, and discharged on post-operative day 5. Conclusion The expertise of both electrophysiology and surgery led to a probable cure for this patient’s AF. At the time of this writing, the patient remains free of AF and continues to do well. and left atrial appendage exclusion for atrial fibrillation. J Thorac Cardiovasc Surg 2005:130:797-802. 2. Pappone C, Santinelli V. Substrate ablation in the treatment of atrial fibrillation. J Cardiovasc Electrophysiol 2006;17:S23-S27. 3. Hwang C, Wu TJ, Doshi RN, et al. Vein of marshall cannulation for the analysis of electrical activity in patients with focal atrial fibrillation. Circulation 2000;101:1503-1505. References 1. Wolf RK, Schneeberger W, Osterday R, et al. Video-assisted bilateral pulmonary vein isolation Follow-up One month later, the patient was seen in follow-up in the CV surgery clinic. He was free of AF and atrial flutter. His beta blocker was being stopped, but he was continued on amiodarone and warfarin. Activity restrictions were lifted and he was planning to begin cardiac rehabilitation. At two months, he remained in sinus rhythm as noted on a one-month monitor and his amiodarone was stopped. He continues to be followed in the AF clinic. For more information: If you would be interested in learning more about the Mini-Maze procedure or the University of Virginia, please visit any of the following websites: www.wolfminimaze.com/ www.minimaze.org/ www.healthsystem.virginia.edu/toplevel/ home/home.cfm The expertise of both electrophysiology and surgery led to a probable cure for this patient’s AF. http://www.wolfminimaze.com/ http://www.minimaze.org/ http://www.healthsystem.virginia.edu/toplevel/home/home.cfm

Table of Contents Feed for the Digital Edition of EP Lab Digest - May 2008

EP Lab Digest - May 2008 Is There an Under-Referral of Women for Atrial Fibrillation Ablation? A Hybrid Approach to the Cure of Atrial Fibrillation Contents Letter from the Editor Spotlight Interview: University of Michigan Health System 10-Minute Interview: Amit J. Shanker, MD Modular EP Units: Are They Possible? One Hospital’s Experience All About My Job: Technician Supervisor (New Column!) Alcohol Septal Ablation in the Cath Lab: What is it All About? About the Canadian Heart Rhythm Society: Interview with Martin J. Gardner, MD, FRCP(C), FACC Email Discussion Group: May 2008 Second Annual Salary Survey My First Year in Electrophysiology: What Have I Got Myself Into? Highlight on Technology: Video-Audio Integration for the EP Lab On the Horizon: A New Remote Catheter Manipulation System Striving for Excellence in the Care of Cardiac Patients Five Reasons to Participate with a Professional Organization Suspected Shunting of Defibrillation Energy in the EP Lab Can Digital Music Players Cause Interference with Implantable Devices? ECG 101: Ambulatory ECG Monitoring Events Calendar Industry News and Products Classifieds Advertisers Index

EP Lab Digest - May 2008

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