Browsing by Subject "Persistent atrial fibrillation"

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    Combined epicardial and endocardial ablation for atrial fibrillation: Best practices and guide to hybrid convergent procedures
    (Elsevier, 2021) Makati, Kevin J.; Sood, Nitesh; Lee, Lawrence S.; Yang, Felix; Shults, Christian C.; DeLurgio, David B.; Melichercik, Juraj; Gill, Jaswinder S.; Kaba, Riyaz A.; Ahsan, Syed; Weerasooriya, Rukshen; Joshi, Pragnesh; Lellouche, Nicolas; Blaauw, Yuri; Zannis, Konstantinos; Sebag, Frederic A.; Gauri, Andre; Zembala, Michael O.; Tondo, Claudio; Steinberg, Jonathan S.; Surgery, School of Medicine
    The absence of strategies to consistently and effectively address nonparoxysmal atrial fibrillation by nonpharmacological interventions has represented a long-standing treatment gap. A combined epicardial/endocardial ablation strategy, the hybrid Convergent procedure, was developed in response to this clinical need. A subxiphoid incision is used to access the pericardial space facilitating an epicardial ablation directed at isolation of the posterior wall of the left atrium. This is followed by an endocardial ablation to complete isolation of the pulmonary veins and for additional ablation as needed. Experience gained with the hybrid Convergent procedure during the last decade has led to the development and adoption of strategies to optimize the technique and mitigate risks. Additionally, a surgical and electrophysiology "team" approach including comprehensive training is believed critical to successfully develop the hybrid Convergent program. A recently completed randomized clinical trial indicated that this ablation strategy is superior to an endocardial-only approach for patients with persistent atrial fibrillation. In this review, we propose and describe best practice guidelines for hybrid Convergent ablation on the basis of a combination of published data, author consensus, and expert opinion. A summary of clinical outcomes, emerging evidence, and future perspectives is also given.
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    Subcutaneous nerve stimulation for rate control in ambulatory dogs with persistent atrial fibrillation
    (Elsevier, 2019-09-01) Yuan, Yuan; Liu, Xiao; Wan, Juyi; Wong, Johnson; Bedwell, Amanda A.; Persohn, Scott A.; Shen, Changyu; Fishbein, Michael C.; Chen, Lan S.; Chen, Zhenhui; Everett, Thomas H.; Territo, Paul R.; Chen, Peng-Sheng; Medicine, School of Medicine
    Background: Subcutaneous nerve stimulation (ScNS) damages the stellate ganglion and improves rhythm control of atrial fibrillation (AF) in ambulatory dogs. Objective: To test the hypothesis that thoracic ScNS can improve rate control in persistent AF. Methods: We created persistent AF in 13 dogs and randomly assigned them to ScNS (N=6) and sham control groups (N=7). 18F-2-Fluoro-2-deoxyglucose (18F-FDG) positron emission tomography / magnetic resonance imaging of the brain stem was performed at baseline and at the end of the study. Results: The average stellate ganglion nerve activity (aSGNA) reduced from 4.00±1.68 μV after the induction of persistent AF to 1.72±0.42 μV (p=0.032) after ScNS. In contrast, the aSGNA increased from 3.01±1.26 μV during AF to 5.52±2.69 μV after sham stimulation (p=0.023). The mean ventricular rate during persistent AF reduced from 149±36 bpm to 84±16 bpm (p=0.011) in ScNS group but no changes were observed in control. Left ventricular ejection fraction (LVEF) remained unchanged in ScNS group but reduced significantly in sham control group. Immunostaining showed damaged ganglion cells in bilateral stellate ganglia and increased brain stem glial cell reaction in the ScNS group but not in the controls. The 18F-FDG uptake in pons and medulla was significantly (p=0.011) higher in the ScNS group than the sham control group at the end of the study. Conclusions: Thoracic ScNS causes neural remodeling in the brain stem and stellate ganglia, controls the ventricular rate and preserves the LVEF in ambulatory dogs with persistent AF.