Bijvoet Geertruida Petronella, Chaldoupi Sevasti-Maria, Bidar Elham, Holtackers Robert J, Luermans Justin G L M, Maesen Bart
Department of Cardiology, Maastricht University Medical Center, P. Debyelaan 25, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.
Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Universiteitssingel 50, 6229 ER, Maastricht, The Netherlands.
Eur Heart J Case Rep. 2021 Dec 27;6(1):ytab530. doi: 10.1093/ehjcr/ytab530. eCollection 2022 Jan.
Surgical epicardial atrial fibrillation (AF) ablation can be performed as a stand-alone (thoracoscopic) procedure or concomitant to other cardiac surgery. In hybrid AF ablation thoracoscopic surgical epicardial ablation is combined with a percutaneous endocardial ablation. The Medtronic Gemini-S clamp is a surgical tool that uses irrigated bipolar biparietal radiofrequency (RF) energy applied with two clamp lesions that overlap to create one epicardial box lesion including the posterior left atrial wall and the pulmonary veins.
We describe three patients with therapy-refractory persistent AF and different stages of atrial remodelling in whom the Medtronic Cardioblate Gemini-S Irrigated RF Surgical Ablation System was used for hybrid AF ablation. Acute endocardial validation at the end of the hybrid ablation revealed a complete box lesion in all three cases. At 2-year follow-up, two out of three patients had recurrence of atrial arrhythmias. Invasive electro-anatomical mapping confirmed the persistence of the box lesion, and the mechanism of arrhythmia recurrence in both patients was unrelated to posterior left atrium or the pulmonary veins. The third patient has been without arrhythmia symptoms since the ablation procedure. A three-dimensional late gadolinium enhancement magnetic resonance imaging illustrates the ablation scar non-invasively in two cases.
Thoracoscopic biparietal RF AF ablation with the Medtronic Cardioblate Gemini-S Irrigated RF Surgical Ablation System results in permanent transmural scar formation, irrespective of the stage of atrial remodelling, as shown in this small population by means of multimodality scar evaluation.
外科心外膜房颤消融可作为独立（胸腔镜）手术进行，也可与其他心脏手术同时进行。在杂交房颤消融中，胸腔镜外科心外膜消融与经皮心内膜消融相结合。美敦力Gemini-S夹是一种手术工具，它使用灌洗式双极双壁射频（RF）能量，通过两个重叠的夹形损伤来创建一个包括左心房后壁和肺静脉的心外膜盒状损伤。
我们描述了3例难治性持续性房颤且处于不同心房重构阶段的患者，他们使用美敦力Cardioblate Gemini-S灌洗式射频手术消融系统进行杂交房颤消融。杂交消融结束时的急性心内膜验证显示，所有3例患者均形成了完整的盒状损伤。在2年的随访中，3例患者中有2例出现房性心律失常复发。有创电解剖标测证实盒状损伤持续存在，且这2例患者心律失常复发的机制均与左心房后壁或肺静脉无关。第3例患者自消融手术后一直没有心律失常症状。三维延迟钆增强磁共振成像在2例患者中无创地显示了消融瘢痕。
如本小样本研究通过多模态瘢痕评估所示，使用美敦力Cardioblate Gemini-S灌洗式射频手术消融系统进行胸腔镜双壁射频房颤消融可导致永久性透壁瘢痕形成，而与心房重构阶段无关。
