Doosang Kim1, Kiwoong Kim2, Yong-Ho Lee2, Eun-Bo Shim3, Seung-Pyung Lim4, Hyuk Ahn5.
1Seoul Veterans Hospital, Seoul, Republic of Korea, 2KRISS, Daejeon, Republic of Korea, 3Kangwon National University, Chuncheon, Republic of Korea, 4Chungnam National University Hospital, Daejeon, Republic of Korea, 5Seoul National University Hospital, Seoul, Republic of Korea.
OBJECTIVE: Map-guided AF surgery is a good help to treat AF. If we know the location of AF source, such as right or left atrium, or isthmus, roof, PV, or auricle of left atrium, etc, we might minimize unnecessary incisions and procedures. Atrial F-wave is very weak and uneven to detect, so it is difficult to trace its abnormal conduction route using conventional ECG method. Magnetocardiography (MCG) action potential mapping is a totally-noninvasive, non-contact and highly sensitive method to detect atrial F-wave for source localization. We report the clinical application cases of MCG map-guided minimal AF surgery.
METHODS: To detect weak atrial excitation, we utilized a high sensitive low-Tc 64-channel MCG system with application software KRISSMCG64 to make a MCG map on the three-dimensional atrial surface. From the information of MCG map, we conducted the minimal AF surgery in seven chronic AF patients with the concomitant valvular or ischemic surgery. Their mean age is 62±10 years old (range; 46-77) and mean LA size is 60±12 mm (range; 45-80). Monthly-based standard 12-lead ECG was used for follow-up examination.
RESULTS: The minimal AF procedures are as follows; 1) Rt PV isolation only, 2) 3/4 PV isolation + minimal RA procedure, 3) RA linear procedure only, 4) 1/2 PV isolation + minimal RA procedure, 5) 1/2 PV isolation + minimal LA, RA procedure, 6) Rt linear + LAA linear procedure, and 7) Rt linear + 3/4 PV isolation respectively. Immediate postoperative rhythms of the all patients were sinus or regular. One patient (6th case) expired at AF rhythm due to severe cerebral embolism on postoperative 15 days. Six of seven chronic AF patients show sinus or regular rhythm with follow-up period of 492, 359, 21, 190, 183 and 36 days respectively. They are all antiarrhythmic drug-off and no sick sinus or no permanent pacemaker insertion.
CONCLUSIONS: MCG map-guided minimal AF surgery might be a new and feasible method to treat AF.
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