Minimally invasive treatment of atrial fibrillation
Atrial fibrillation is the most common cardiac arrhythmia.
The atrial chambers show chaotic electrical activity and uncoordinated mechanical activity; the heartbeat is irregular with extreme variability in rate, which can range from very high to very low. Typically, it is associated with the onset of palpitations, shortness of breath, difficulty breathing (dyspnoea), or reduced tolerance to exertion or exercise, but it can also be asymptomatic.
The consequences of this arrhythmia can be very serious: in particular, among the most feared are thromboembolic events (stroke), left ventricular dysfunction and heart failure, cognitive impairment (dementia), depression, impairment of quality of life and even an increased risk of death.
The Adult Cardiac Surgery Unit ensures the treatment of this pathology both in patients with isolated atrial fibrillation and in cases of atrial fibrillation concomitant with other cardiac conditions, through the following surgical procedures.
- Epicardial thoracoscopic ablation: thanks to the use of a small camera (videoscopic probe), it is possible to reach the outer surface of the heart (epicardium) through the so-called thoracoscopic approach (three small holes in the chest wall), with which a radiofrequency ablation procedure is performed with a beating heart and without the use of extracorporeal circulation, which makes it possible to interrupt the “electrical short-circuit” that causes and maintains the arrhythmia. Candidates for this procedure are those with recurrent paroxysmal atrial fibrillation who have already been treated with a transcatheter ablation procedure, those with recurrent paroxysmal atrial fibrillation who cannot undergo a transcatheter ablation procedure for technical or anatomical reasons (e.g. presence of inter-atrial devices), patients with persistent or long-standing persistent atrial fibrillation in the context of a sequential combined epicardial thoracoscopic and endocardial (from within the heart) percutaneous transcatheter treatment protocol.
- Exclusion of the left auricle: again through the use of an endoscopic probe, it is possible to reach the left auricle via left thoracoscopy and place a device at its base that ensures its complete closure and exclusion from the circuit; in this way, the most common site of thrombus formation and origin of emboli is eliminated and the risk of stroke in the long term is markedly reduced.
- Concomitant ablation with minimally invasive thoracotomy/endoscopic approach: a procedure designed for the treatment of concomitant atrial fibrillation during cardiac surgery performed with a minimally invasive approach, e.g. during valve repair procedures.
- Concomitant ablation with sternotomy approach: a procedure designed to treat concomitant atrial fibrillation during other cardiac surgery requiring a conventional approach, e.g. during myocardial revascularisation procedures (aortocoronary bypass).