A new approach in the treatment of patients with coronary artery disease and atrial fibrillation

Objective: to assess the possibility of simultaneous coronary artery bypass grafting and novel technique for left atrial posterior wall isolation (box-lesion) on a beating heart (off-pump) using Cardioblate Gemini-S (Medtronic. inc) thoracoscopic electrodes for bipolar surgical ablation. Methods: within the period of August 2019 to January 2020, nine patients were operated in our clinic. We performed simultaneous coronary artery bypass grafting on the beating heart combined with left atrial posterior wall isolation (box-lesion scheme) using Cardioblate Gemini-S electrodes in patients with coronary artery disease and atrial fibrillation (AF). The average age of the patients was 67 years old, all patients were male. Paroxysmal AF was diagnosed in 2 patients, and 7 patients had persistent atrial fibrillation. Duration of the atrial fibrillation was 26 months. All patients underwent off-pump coronary artery bypass grafting. The revascularization index was 3. The left internal thoracic artery was used to bypass the anterior descending artery in all patients and the other coronary vessels were revascularized with venous grafts. After myocardial revascularization, all patients underwent radiofrequency left atrial posterior wall isolation (box-lesion scheme ) using Cardioblate Gemini-S electrodes. Ablations time was 18 minutes. Finally, the left atrial appendage resection with a stapler and bilateral epicardial stimulation were performed. Results: the total operation time was 190 minutes. Sinus rhythm in patients with persistent atrial fibrillation was restored at the end of procedures due to cardioversion. Periprocedural complications, such as myocardial infarction, a stroke or a transient ischemic attack, reoperation for bleeding, were not observed. There were no cases of bradyarrhythmia requiring implantation of the permanent pacemaker. All patients were discharged in sinus rhythm. Conclusion: cardioblate Gemini-S thoracoscopic electrodes allow us to perform combined intervention, that is coronary artery bypass grafting and radiofrequency left atrial posterior wall isolation (the box-lesion” scheme), without artificial blood circulation. This approach allows us to reduce potential risks of developing perioperative complications in patients with coronary artery disease and atrial fibrillation. We believe this original technique is available for high-risk patients.