BACKGROUND: Patients with recent coronary artery bypass graft (CABG) surgery are at risk for early graft failure, which is associated with a risk of myocardial infarction and death. In the COMPASS (Cardiovascular OutcoMes for People Using Anticoagulation StrategieS) trial, rivaroxaban 2.5 mg twice daily plus aspirin 100 mg once daily compared with aspirin 100 mg once daily reduced the primary major adverse cardiovascular events (MACE) outcome of cardiovascular death, stroke, or myocardial infarction. Rivaroxaban 5 mg twice daily alone did not significantly reduce MACE. OBJECTIVES: This pre-planned substudy sought to determine whether the COMPASS treatments are more effective than aspirin alone for preventing graft failure and MACE after CABG surgery. METHODS: The substudy randomized 1,448 COMPASS trial patients 4 to 14 days after CABG surgery to receive the combination of rivaroxaban plus aspirin, rivaroxaban alone, or aspirin alone. The primary outcome was graft failure, diagnosed by computed tomography angiogram 1 year after surgery. RESULTS: The combination of rivaroxaban and aspirin and the regimen of rivaroxaban alone did not reduce the graft failure rates compared with aspirin alone (combination vs. aspirin: 113 [9.1%] vs. 91 [8.0%] failed grafts; odds ratio [OR]: 1.13; 95% confidence interval [CI]: 0.82 to 1.57; p = 0.45; rivaroxaban alone vs. aspirin: 92 [7.8%] vs. 92 [8.0%] failed grafts; OR: 0.95; 95% CI: 0.67 to 1.33; p = 0.75). Compared with aspirin, the combination was associated with fewer MACE (12 [2.4%] vs. 16 [3.5%]; hazard ratio [HR]: 0.69; 95% CI: 0.33 to 1.47; p = 0.34), whereas rivaroxaban alone was not (16 [3.3%] vs. 16 [3.5%]; HR: 0.99, CI: 0.50 to 1.99; p = 0.98). There was no fatal bleeding or tamponade within 30 days of randomization. CONCLUSIONS: The combination of rivaroxaban 2.5 mg twice daily plus aspirin or rivaroxaban 5 mg twice daily alone compared with aspirin alone did not reduce graft failure in patients with recent CABG surgery, but the combination of rivaroxaban 2.5 mg twice daily plus aspirin was associated with similar reductions in MACE, as observed in the larger COMPASS trial. (Cardiovascular OutcoMes for People Using Anticoagulation StrategieS [COMPASS]; NCT01776424).

• MeSH
• Aspirin terapeutické užití   MeSH
• dvojitá slepá metoda MeSH
• fibrinolytika terapeutické užití   MeSH
• inhibitory faktoru Xa terapeutické užití   MeSH
• kombinovaná farmakoterapie MeSH
• koronární bypass * MeSH
• lidé středního věku MeSH
• lidé MeSH
• okluze cévního štěpu prevence a kontrola   MeSH
• rivaroxaban terapeutické užití   MeSH
• senioři MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH

OBJECTIVES: Thoracoscopic occlusion of the left atrial appendage (LAA) has become a routine part of thoracoscopic ablation for the treatment of atrial fibrillation (AF). Evaluation of residual findings of the occluded LAA by echocardiography has yet to be described. METHODS: Patients with AF indicated for hybrid ablation (thoracoscopic procedure followed by catheter ablation) were enrolled in this study. LAA was occluded as a routine part of the thoracoscopic procedure. Follow-up transoesophageal echocardiography was performed at the end of the procedure, 2-5 days and 2-3 months after the procedure (before the endocardial stage). The residual pouches of the LAA were measured in the mitral valve view (30-110°) and in the perpendicular view. The depth of the residual pouch was measured from the ostial plane (connecting the Coumadin ridge and the circumflex artery) to the deepest part of the residuum. The volume of the residual pouch and the distance from the circumflex artery to the proximal and the distal ends of the AtriClip were measured using computed tomography. RESULTS: Forty patients were enrolled in this study. The success rate for the occlusion of the LAA, assessed on transoesophageal echocardiography 2-5 days after surgery, was 97.5%. Regarding the residual findings, no reperfused LAAs were found, and only residual stumps remained. The depth of the stump was 12.9 ± 5.9 mm, the area was 2.2 ± 1.1 cm2, and the volume was 3.6 ± 1.9 ml (all data are shown as mean ± standard deviation). CONCLUSIONS: The occlusion of the LAA using an AtriClip PRO device was a clinically safe procedure with high efficacy and was associated with the presence of a small residual pouch after occlusion. Clinical trial registration: NCT02832206.

• MeSH
• echokardiografie transezofageální MeSH
• fibrilace síní diagnostické zobrazování   chirurgie   MeSH
• katetrizační ablace * MeSH
• lidé středního věku MeSH
• lidé MeSH
• počítačová rentgenová tomografie MeSH
• senioři MeSH
• síňové ouško diagnostické zobrazování   chirurgie   MeSH
• torakoskopie * MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

PURPOSE: This study was designed to investigate the distribution of vasa vasorum in walls of failed aorto-coronary venous grafts. METHODS: Fifty-one diseased venous grafts harvested from 39 patients underwent qualitative histological evaluation. The morphology of the grade of the pathological changes and the extent of the vascularisation were examined, and related to the length of the interval between the primary surgery and the explantation. The obtained results were placed into five groups, substantially differing one from the other in morphology and vascularisation. RESULTS: The intervals between grafts implantation and explantation ranged from 1 day to 35 years. The onset of arterialization of the graft media was observed on average at 1 month after bypass implantation. During this same time period massive intimal hyperplasia and atherosclerosis occurred. Vasa vasorum proliferation from the adventitia to the outer layers of the media was first apparent between 7 and 24 months after implantation. Proliferation of the vasa vasorum throughout the entire atherosclerotic media and hyperplastic intima continued for a much longer time interval. CONCLUSION: No correlation between neoangiogenesis and age, sex or type of bypassed coronary branch was proven. Regarding the given findings, the authors believe that changes in hemodynamic conditions and endothelial trauma are primarily responsible for the development of graft disease and that vasa vasorum proliferation is only a secondary reaction to the structural changes of the graft wall. To what extent the frequently present pre-existing intimal hyperplasia of venous bypass grafts play in the development of graft disease remains questionable.

• MeSH
• aorta patologie   chirurgie   MeSH
• časové faktory MeSH
• koronární bypass metody   MeSH
• koronární nemoc patologie   chirurgie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• terapie neúspěšná MeSH
• vasa vasorum patologie   MeSH
• vény patologie   transplantace   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

OBJECTIVES: Hybrid ablation of atrial fibrillation (AF) is a promising treatment strategy; however, data regarding its efficacy and safety are still limited. METHODS: Patients with non-paroxysmal AF were enrolled. First, a thoracoscopic, epicardial isolation of pulmonary veins and the left atrial posterior wall ('box lesion') was performed; a novel unipolar/bipolar radiofrequency device was used. Moreover, in 12 patients enrolled thereafter, the left atrial appendage was occluded. Electrophysiological evaluation and catheter ablation were performed 2-3 months later, with the goal of verifying or completing (if needed) the box lesion and ablation of the ganglionated plexi and the cavotricuspid isthmus. Outcomes were assessed using 1-week and 24-h Holter monitoring, repeated echocardiography and laboratory measurements. RESULTS: Thirty-eight patients (13 persistent and 25 long-standing persistent AF) were enrolled with a mean AF duration of 33 ± 32.9 months. The procedure was successfully completed in 35 patients; 3 patients underwent only the surgical part because of a postoperative left atrial appendage thrombus (2 patients) and perioperative stroke (1 patient). After 6 months, 30 (86%) patients were arrhythmia-free, whereas 80% were also off antiarrhythmics. After 1 year, 28 (82%) patients were arrhythmia-free, 79% were off anti-arrhythmics and 47% were off anticoagulation treatment. Four (10.5%) serious postoperative complications occurred, including 1 stroke, 1 right phrenic nerve palsy and 2 pneumothoraxes with a need for drainage. Significant improvements were observed in echocardiographic, functional and serological parameters. CONCLUSIONS: Hybrid ablation is an effective treatment strategy for patients with persistent or long-standing persistent AF. Over 80% of patients were arrhythmia-free 1 year after the procedure. Sinus rhythm restoration was accompanied by improvements in functional, echocardiographic and serological markers.

• MeSH
• antiarytmika terapeutické užití   MeSH
• echokardiografie MeSH
• elektrokardiografie ambulantní MeSH
• fibrilace síní chirurgie   MeSH
• katetrizační ablace * MeSH
• lidé středního věku MeSH
• lidé MeSH
• následné studie MeSH
• obnova funkce MeSH
• senioři MeSH
• venae pulmonales chirurgie   MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

PURPOSE: Hybrid ablation of atrial fibrillation (AF) is a promising treatment strategy for patients with non-paroxysmal AF, although, data regarding mid-term outcomes are limited. METHODS: Patients with persistent or long-standing persistent AF were enrolled. Initially, a thoracoscopic, right-sided, epicardial ablation was performed, with a goal of creating a box lesion on the posterior wall of the left atrium; a novel versapolar radiofrequency (RF) catheter was used. In patients enrolled later, occlusion of the left atrial appendage was also performed. An endocardial procedure was performed 2-4 months later, with the goal of confirming/completing the box lesion and ablating the ganglionated plexi and cavotricuspid isthmus. Efficacy was assessed using multiple 24-h and 1-week Holter monitoring. Analysis was performed to search for variables associated with procedure's failure. RESULTS: Forty-one patients (14 persistent and 27 long-standing persistent AF) were enrolled with a mean AF duration of 33.5 ± 33.1 months. Mean follow-up was 507.2 ± 201.1 days (180-731). At the last follow-up visit, 27(65%) patients were arrhythmia-free, without anti-arrhythmics or need for re-ablation. Additional 4 patients (9.8%) were in sinus rhythm (SR) following re-ablation of postprocedural peri-mitral flutter and 4 (9.8%) were in SR on anti-arrhythmics. Longer periods of preoperative AF were independently associated with worse arrhythmia-free survival (p = 0.015). Serious postoperative complications occurred in 3 (7.3%) patients; only 1 (2.4%) patient had clinical consequences after 6 months. CONCLUSIONS: Hybrid ablation of non-paroxysmal AF using a novel, versapolar RF device yields promising mid-term results. Better arrhythmia-free survival rates were found in AF patients with shorter AF duration.

• MeSH
• bezpečnost vybavení MeSH
• časové faktory MeSH
• chronická nemoc MeSH
• design vybavení MeSH
• elektrokardiografie ambulantní metody   MeSH
• elektrokardiografie metody   MeSH
• fibrilace síní diagnostické zobrazování   chirurgie   MeSH
• hodnocení rizik MeSH
• katetrizační ablace přístrojové vybavení   metody   MeSH
• kohortové studie MeSH
• lidé středního věku MeSH
• lidé MeSH
• monitorování fyziologických funkcí přístrojové vybavení   metody   MeSH
• následné studie MeSH
• recidiva MeSH
• retrospektivní studie MeSH
• senioři MeSH
• stupeň závažnosti nemoci MeSH
• výsledek terapie MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

Úvod: Léčba perzistentní a dlouhodobě perzistentní fibrilace síní není uspokojivě vyřešena pomocí katetrizační ablace či farmakoterapie. Nadějnou a stále častěji používanou metodou jsou tzv. hybridní ablace, tedy kombinace miniinvazivní kardiochirurgické ablace s následným elektrofyziologickým vyšetřením a endokardiální katetrizační ablací, která celou ablaci dokončí. Metoda: Prováděna byla thorakoskopická ablace plicních žil a zadní stěny levé síně (tzv. box-léze) systémem COBRA Fusion, u pozdějších pacientů doplněná o uzávěr ouška levé síně systémem AtriClip. Po 2−3 měsících pacienti podstoupili elektrofyziologické vyšetření a katetrizační ablaci. V článku shrnujeme strategii chirurgické části hybridní ablace prováděné na našem pracovišti a popisujeme vlastní operaci a krátkodobé výsledky, zejména ve vztahu k následným nálezům elektrofyziologů. Výsledky: Analyzována byla data prvních 51 pacientů. Prvních 25 pacientů podstoupilo jen unilaterální ablaci, průměrný čas výkonu byl 102 minut, u následujících 26 pacientů (bilaterální výkon) to bylo 160 minut. Závažnými komplikacemi byl 1 iktus, 1 paréza n. phrenicus a 2 operační revize pro krvácení. Po měsíci mělo 65 % pacientů sinusový rytmus. Box-léze byla při elektrofyziologickém vyšetření kompletní u 38 % pacientů a po katetrizační ablaci odcházelo 96 % pacientů se sinusovým rytmem. Závěr: Chirurgická část hybridní ablace pomocí miniinvazivního přístupu s využitím katétru COBRA Fusion je dobře proveditelnou metodou s nízkým počtem perioperačních komplikací a poskytuje elektrofyziologům velmi dobrý základ pro úspěšné dokončení hybridní ablace.

Introduction: Treatment of persistent and long-standing persistent atrial fibrillation is not successfully managed by methods of catheter ablation or pharmacotherapy. Hybrid ablation (i.e. combination of minimally invasive surgical ablation, followed by electrophysiological assessment and subsequent endocardial catheter ablation to complete the entire intended procedure) presents an ever more used and very promising treatment method. Method: Patients underwent thoracoscopic ablation of pulmonary veins and posterior wall of the left atrium (the box-lesion) with use of the COBRA Fusion catheter; thoracoscopic occlusion of the left atrial appendage using the AtriClip system was also done in later patients. After 2−3 months, electrophysiological assessment and catheter ablation followed. In this article we summarize a strategy of the surgical part of the hybrid procedure performed in our centre. We describe the surgery itself (including possible periprocedural complications) and we also present our short-term results, especially with respect to subsequent electrophysiological findings. Results: Data of the first 51 patients were analyzed. The first 25 patients underwent unilateral ablation; the mean time of surgery was 102 min. Subsequent 26 patients underwent the bilateral procedure with the mean surgery time of 160 min. Serious complications included 1 stroke, 1 phrenic nerve palsy and 2 surgical re-explorations for bleeding. After 1 month, 65% of patients showed sinus rhythm. The box-lesion was found complete during electrophysiological assessment in 38% of patients and after catheter ablation, 96% of patients were discharged in sinus rhythm. Conclusion: The surgical part of the hybrid procedure with use of the minimally invasive approach and the COBRA Fusion catheter is a well-feasible method with a low number of periprocedural complications. For electrophysiologists, it provides a very good basis for successful completion of the hybrid ablation.

• Klíčová slova
• hybridní ablace,
• MeSH
• antikoagulancia MeSH
• elektrofyziologické techniky kardiologické MeSH
• fibrilace síní * chirurgie   terapie   MeSH
• heparin terapeutické užití   MeSH
• katetrizační ablace MeSH
• lidé MeSH
• miniinvazivní chirurgické výkony MeSH
• torakoskopie * metody   MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH

BACKGROUND: Catheter and surgical ablation of atrial fibrillation (AF) can be associated with a risk of thromboembolic events. The goal of this study was to assess optimal anticoagulation management during thoracoscopic ablation of AF. METHODS: Fifty-two patients with persistent or long-standing persistent AF underwent hybrid ablation consisting of thoracoscopic ablation followed by electrophysiologic (EP) evaluation and consecutive ablation if indicated. The thoracoscopic ablation was performed using three different anticoagulation protocols: (1) without periprocedural heparin and without occlusion of the left atrial appendage; (2) with periprocedural heparin but without left atrial appendage occlusion; and (3) with periprocedural heparin and left atrial appendage occlusion. Transesophageal echocardiography (TEE) was obligatorily used to screen for intraatrial thrombi before the surgical and EP procedure and before hospital discharge for patients in protocols 2 and 3. RESULTS: In group 1 (n = 20), 1 patient (5%) had a postoperative stroke with persistent neurologic deficit, and 6 other patients (30%) had a new thrombus in the left atrial appendage seen on the pre-EP TEE. In group 2 (n = 6), 3 left atrial appendage thrombi occurred (50%; 2 on predischarge TEE and 1 on pre-EP TEE). In group 3 (n = 26), no intracardiac thrombi were found on predischarge and pre-EP TEE, and there were no strokes in this group of patients, namely, the rates of thrombus or stroke were significantly reduced when compared with groups 1 and 2 (p = 0.001). CONCLUSIONS: Thoracoscopic ablation of AF can be associated with a risk of left atrial appendage thrombus formation and possibly also stroke. With administration of heparin during the ablation, followed by occlusion of the left atrial appendage as a part of the procedure, this risk can be effectively reduced.

• MeSH
• antikoagulancia farmakologie   MeSH
• cévní mozková příhoda etiologie   prevence a kontrola   MeSH
• dospělí MeSH
• fibrilace síní komplikace   chirurgie   MeSH
• heparin farmakologie   MeSH
• incidence MeSH
• katetrizační ablace škodlivé účinky   metody   MeSH
• lidé středního věku MeSH
• lidé MeSH
• následné studie MeSH
• rizikové faktory MeSH
• senioři MeSH
• síňové ouško chirurgie   MeSH
• torakoskopie metody   MeSH
• trombóza epidemiologie   etiologie   prevence a kontrola   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH

Background: Hybrid ablation [thoracoscopic ablation (TA) of atrial fibrillation (AF) followed by catheter ablation (CA)] is an increasingly common method of the treatment for patients with AF. The aim of this study was to assess the response to ganglionated plexi (GP) ablation in patients with a previous TA (i.e., to assess whether TA had resulted in damage to the GP. Heart rate variability (HRV) was used as a marker of the autonomic response. Methods: Twenty AF patients underwent pulmonary vein isolation (PVI) plus GP ablation (GP group) and 18 AF patients underwent CA including GP ablation as a part of hybrid ablation (i.e., all patients had undergone a previous TA; Hybrid group). In each group, a 5 min electrocardiogram (ECG) obtained before and after the CA were analyzed. Time and frequency domain parameters were evaluated. Results: Vagal responses (VR) during CA were observed in 12 (60%) patients in the GP group; however, in the Hybrid group, VR was not observed in any of the patients during CA. The change in normalized power in the low frequency (LF) component and the ratio between the LF and high frequency (LF/HF ratio) components of the HRV spectra, before and after ablation, were statistically significant in the GP group (3.3±2.6 beforevs.1.8±1.9 after ablation) but unchanged, before or after CA, in the Hybrid group. Conclusions: GP ablation in patients subsequent to TA has a little influence on HRV parameters, which could be explained by GP damage during the preceding TA.

• Publikační typ
• časopisecké články MeSH

Úvod: I při technicky úspěšně provedené hybridní ablaci ve formě „box-léze“ zadní stěny levé síně dochází u některých pacientů k recidivám fibrilace síní (FS) a/nebo pravidelných síňových arytmií (AT). Cílem této studie bylo popsat incidenci a typy AT vyskytujících se po úspěšné hybridní ablaci. Metodika: Do studie byli zařazováni pacienti po hybridní ablaci pro perzistentní nebo dlouhodobě perzistentní fibrilaci síní. U pacientů, u nichž došlo k vzniku AT, bylo doporučeno provést elektrofyziologické vyšetření (EFV) a opakovanou ablaci. Mechanismus AT byl popsán pomocí aktivačního a entrainment mapování. Výsledky: Síňová arytmie se vyskytla u 5 (10 %) z 50 pacientů, u nichž byla provedena hybridní ablace. Mechanismem AT byl u čtyř pacientů perimitrální flutter, zatímco u posledního pacienta byl přítomen typický isthmus-dependentní pravosíňový flutter. Po ablaci klinické arytmie bylo možno indukovat další AT a provést jejich ablaci u dvou pacientů; na konci výkonu bylo u všech pacientů dosaženo neinducibility jakékoli arytmie. Všichni pacienti s AT byli bez detekce jakékoli další AT nebo FS během dalšího ambulantního sledování v délce 285 ± 122 dní. Závěr: Incidence AT u pacientů po hybridním ablačním výkonu byla 10 %, přičemž ve většině případů se jednalo o perimitrální flutter.

Background: Despite successful creation of box lesions during hybrid ablations, reoccurrence of atrial fibrillation (AF) and/or regular atrial arrhythmias (ATs) still occur. The goal of this study was to describe the incidence and types of regular ATs that occur after successful hybrid ablations. Methods: Patients after hybrid ablation for persistent or long-standing persistent AF were enrolled. Patients, in whom regular AT occurred, were recommended for electrophysiological study and re-ablation. The mechanism of regular AT was described using activation and entrainment mapping. Results: Regular AT occurred in 5 (10%) patients from 50 patients, in whom hybrid ablation has been performed. Peri-mitral flutter was found to be the mechanism of clinical AT in 4 patients, in the last patient, a typical right sided isthmus-dependent flutter was present. After ablation of the clinical arrhythmia, other ATs were inducible and ablated in two patients resulting in non-inducibility of any arrhythmia at the end of the procedure in all patients. All patients with regular AT were free of symptoms and free of any further tachyarrhythmia or AF during follow-up of 285 ± 122 days. Conclusion: The incidence of regular AT in patients after hybrid ablation procedure was 10%, with the majority of them being associated with re-entry around the mitral annulus.

• MeSH
• ablace metody   MeSH
• epikardiální mapování MeSH
• fibrilace síní * epidemiologie   chirurgie   MeSH
• katetrizační ablace metody   přístrojové vybavení   MeSH
• lidé středního věku MeSH
• lidé MeSH
• recidiva MeSH
• srdeční elektrofyziologie metody   MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• Publikační typ
• práce podpořená grantem MeSH

• MeSH
• antiarytmika aplikace a dávkování   normy   MeSH
• fibrilace síní * farmakoterapie   chirurgie   klasifikace   MeSH
• heparin normy   terapeutické užití   MeSH
• kardiochirurgické výkony metody   MeSH
• lidé MeSH
• síňové ouško chirurgie   MeSH
• společnosti lékařské MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• směrnice pro lékařskou praxi MeSH