Atrial fibrillation (AF) is the most common cardiac arrhythmia and causes an irregular and often high frequency. This arrhythmia is associated with stroke, heart failure and death. The exact mechanism of AF is not completely understood. It is known that when AF arises, the cardiac tissue remodels. This is why early detection and treatment is pivotal. Guidelines recommend pharmacological treatment as first choice although this is only moderately effective. For patients with recurrent and symptomatic AF, catheter ablation is recommended. With this treatment the pulmonary veins are isolated from the left atrium. An alternative for this method is a thoracoscopic approach. The aim of this thesis was to investigate the results of different treatment strategies for symptomatic AF. We investigated the long-term results of transcatheter ablation in a large cohort. Main finding was that patients with obesity have significantly reduced long-term outcomes. Then we compared the 1-year results of transcatheter with thoracoscopic ablation; efficacy was higher following thoracoscopic ablation but also more complications were observed. The high efficacy was confirmed in our large 2-year follow-up study and results were maintained at 5-year follow-up. Thoracoscopic approach offers the opportunity to close the left atrial appendage. Our research showed that the contraction function of the left atrium was not impaired by the appendage closure. In summary, AF is a complex disease with multiple treatment options. Modern treatment of this arrhythmia calls for a multidisciplinary heart team approach. This thesis underlines the importance of collaboration between electrophysiologists and cardio-thoracic surgeons.
|Translated title of the contribution||Boezemfibrilleren ablatie: tijd voor een hartteam benadering|
|Qualification||Doctor of Philosophy|
|Place of Publication||[Groningen]|
|Publication status||Published - 2018|