Thoracoscopic Radiofrequency Fragmentation of the Left Atrium as a Bridge to Decision Before Heart Transplant

Abstract

Objectives: Atrial fibrillation and congestive heart failure can provoke and aggravate each other. Often the boundaries between those diseases are ambiguous, and successful diagnosis is initially elusive. However, the last stage of congestive heart failure can lead the patient to heart transplant. We suggested that restoration and stabilization of sinus rhythm could be used as a differential diagnostic criterion to distinguish dilated cardiomyopathy from atrial fibrillation. We investigated the possibility that thoracoscopic radiofrequency fragmentation of the left atrium could be a valid a bridge to decision before heart transplant in patients with the combination of atrial fibrillation and congestive heart failure with reduced left ventricular ejection fraction.

Materials and methods: The pilot study included 3 men who consecutively received thoracoscopic radiofrequency fragmentation of the left atrium from November 2021 to May 2022. All 3 patients had a combination of atrial fibrillation and congestive heart failure with a reduced ejection fraction and left ventricle dilatation (echocardiography, Simpson method: 31%, 33%, and 30%, respectively) despite receiving as highly as possible drug therapy and normalization of heart rate. The patients were 42, 38, and 55 years old, with rates of N-terminal pro-B-type natriuretic peptide of 3047, 2548, and 2542 pg/mL, respectively.

Results: The follow-up examination was performed every month. The total durations of the follow-up were 12, 9, and 7 months, respectively. By month 3 after the surgery, the left ventricular ejection fraction began to increase. By month 6 of follow-up, the left ventricular ejection fraction reached its maximum value and stabilized. All patients reported cessation of congestive heart failure symptoms.

Conclusions: Thoracoscopic radiofrequency fragmentation of the left atrium can be considered a bridge to decision before heart transplant in patients with a combination of atrial fibrillation and congestive heart failure with reduced left ventricular ejection fraction.