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Örebro Studies in Medicine 169 I

ÖREBRO 2017 2017

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issn 1652-4063 isbn 978-91-7529-220-5

Atrial Fibrillation

Endoscopic ablation and Postoperative studies

ESPEN FENGSRUD

Medical Science with a specialization in Medicine

espen fengsrud was born in Hamar, Norway, in 1970

and received his medical degree 1998 from University of Oslo. He started his training at Lindesberg Lasarett and since 2004 he has worked at the Department of Cardiology at Örebro University hospital. He became specialist in Internal Medicine 2006 and in Cardiology 2008. For the last twelve years he has been part of the Arrhythmia unit, initially working with pacemakers and Implanteable Car-dioverter Defibrillators (ICD), now mainly as a consultant in electrophysiology performing catheter ablations. He started atrial fibril-lation research under the tutorship of Associate Professor Anders Ahlsson and Associate Professor Anders Englund.

In Sweden 300 000 people have atrial fibrillation (AF). It is associated with an increased risk of stroke, heart failure and cardiovascular death. Some patients are asymptomatic while others are highly symptomatic with reduced quality of life. In patients undergoing aortocoronary bypass graft (CABG) surgery one-third experience an episode of AF. In most cases it is self-terminating and the patient is discharged in sinus rhyhtm. The long-term effects on heart rhythm have not been studied. Total endoscopic ablation is an alternative to catheter ablation(CA) in certain patients with symptomatic AF, but its clinical role needs further evaluation. In patients with long-standing persistent AF, continuous duration >12 months, CA is ineffective.

In this thesis we showed that postoperative AF is a major risk factor for future AF and cardiovascular morbidity and mortality. AF was an independent risk factor regardless of whether it was present before or after surgery. Better fol-low up strategies and anticoagulation treatment is of importance. We also describe the technique of total endoscopic ablation of AF using a right-sided unilateral approach. In our first ten patients with one year follow up it was feasible and safe with acceptable results. In a prospective controlled study, 36 patients aged >50 years with symptomatic long-standing persistent AF were randomized to either total endoscopic ablation or rate control therapy. Loop recorders for continues arrhythmia detection were implanted in all patients. Total endoscopic ablation significantly reduced AF burden at 12 months compared with controls. Myocardial function, physical working capacity and subjective physical and mental health improved.

Doctoral Dissertation

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References

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