Ablation of atrial fibrillation: Moving to a heart team approach

Gijs Eduard de Maat

Ablation of atrial fibrillation: Moving to a heart team approach

Vertaalde titel van de bijdrage: Boezemfibrilleren ablatie: tijd voor een hartteam benadering

Gijs Eduard de Maat

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Boezemfibrilleren is de meest voorkomende hartritmestoornis welke zorgt voor een onregelmatig en meestal snel hartritme. Deze ritmestoornis is geassocieerd met hartfalen en overlijden.
Het mechanisme van boezemfibrilleren is nog steeds niet volledig begrepen. Wel weten we dat als boezemfibrilleren eenmaal bestaat, verandering van het hartweefsel optreedt. Daarom moet boezemfibrilleren vroegtijdig worden opgespoord en behandeld. Richtlijnen adviseren medicatie als eerste behandeling van boezemfibrilleren, hoewel het succes beperkt is. Voor patiënten die desondanks klachten van terugkerend boezemfibrilleren hebben wordt katheterablatie geadviseerd. Hiermee worden de longvenen van de boezem geïsoleerd om boezemfibrilleren te stoppen. Een alternatief voor deze methode is longveneisolatie via thoracoscopie (kijkoperatie).
Het doel van dit proefschrift was om de uitkomsten van verschillende minimaal invasieve ablatiemethodes te onderzoeken. We onderzochten een grote groep patiënten die katheter ablatie ondergingen. De belangrijkste bevinding was dat het lange termijn succes van deze methode lager is bij patiënten met obesitas. Verder hebben wij de 1-jaars resultaten van katheterablatie vergeleken met thoracoscopische ablatie; de thoracosopische methode is effectiever maar geeft ook meer complicaties. Het succes van thoracoscopische ablatie werd bevestigd op middellange termijn (2 jaar) en ook op lange termijn (5-jaars) blijkt deze methode effectief. Om beroertes te voorkomen biedt de thoracoscopische benadering de mogelijkheid om het linker hartoor te sluiten. Dit onderzoek toonde aan dat de knijpfunctie van de linker boezem niet wordt aangetast door het sluiten. Samengevat is boezemfibrilleren een complexe ziekte met verschillende behandelopties. De moderne behandeling van boezemfibrilleren vraagt daarom maatwerk van een hartteam waarin de cardioloog en hartchirurg goed samenwerken.

Vertaalde titel van de bijdrage	Boezemfibrilleren ablatie: tijd voor een hartteam benadering
Originele taal-2	English
Kwalificatie	Doctor of Philosophy
Toekennende instantie	Rijksuniversiteit Groningen
Begeleider(s)/adviseur	Mariani, Massimo, Supervisor van Gelder, Isabelle, Supervisor Rienstra, Michiel, Co-supervisor Blaauw, Yuri, Co-supervisor van den Berg, Maarten, Beoordelingscommissie
Datum van toekenning	25-apr.-2018
Plaats van publicatie	[Groningen]
Uitgever	Rijksuniversiteit Groningen
Gedrukte ISBN's	978-94-6361-086-5
Status	Published - 2018

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Title and contentsFinal publisher's version, 615 KB
Chapter 1Final publisher's version, 1,36 MB
Chapter 2Final publisher's version, 672 KB
Chapter 3Final publisher's version, 642 KB
Chapter 4Final publisher's version, 588 KB
Chapter 5Final publisher's version, 775 KB
Chapter 6Final publisher's version, 642 KB
Chapter 7Final publisher's version, 676 KB
Chapter 8Final publisher's version, 1,79 MB
Chapter 9Final publisher's version, 654 KB
Chapter 10Final publisher's version, 1,28 MB
Chapter 11Final publisher's version, 1,57 MB
AppendicesFinal publisher's version, 609 KB
Complete thesisFinal publisher's version, 5,09 MB
PropositionsFinal publisher's version, 578 KB

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@phdthesis{66d68b7616344065b08b3b13ac6997c2,

title = "Ablation of atrial fibrillation: Moving to a heart team approach",

abstract = "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.",

author = "{de Maat}, {Gijs Eduard}",

year = "2018",

language = "English",

isbn = "978-94-6361-086-5",

publisher = "Rijksuniversiteit Groningen",

school = "University of Groningen",

}

TY - BOOK

T1 - Ablation of atrial fibrillation

T2 - Moving to a heart team approach

AU - de Maat, Gijs Eduard

PY - 2018

Y1 - 2018

N2 - 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.

AB - 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.

M3 - Thesis fully internal (DIV)

SN - 978-94-6361-086-5

PB - Rijksuniversiteit Groningen

CY - [Groningen]

ER -

Ablation of atrial fibrillation: Moving to a heart team approach

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