Epicardial Ablation

 

Definitions

Epicardial ablation, or ablation of cells on the outside the heart muscle, is used when standard catheter ablation from inside the heart is not successful in identifying the region of heart tissue responsible for a heart rhythm problem and the critical region of heart tissue is found to be on the outside of the heart.6
 

Why it's needed

Surgical ablation for Atrial Fibrillation is recommended at the time of concomitant mitral operations to restore sinus rhythm.1
Concomitant surgical ablation is recommended

Total endoscopic ablation of atrial fibrillation is a treatment option in symptomatic patients after unsuccessful catheter ablation or when catheter ablation is considered inappropriate4.
 

Indications

In 2012, a task force, which included the Society of Thoracic Surgeons, the American College of Cardiology, the Heart Rhythm Society, the European Heart Rhythm Association, and the European Cardiac Arrhythmia Society, released the updated consensus indications for surgical ablation that were divided into two separate categories: those patients undergoing a concomitant cardiac surgery and those who are not undergoing a concomitant cardiac surgery. For those undergoing other cardiac surgical procedures, all patients with symptomatic atrial fibrillation should be considered for surgical ablation, regardless of whether antiarrhythmic medications have been started. However, stand-alone surgical ablation is generally indicated after patients have failed medical therapy and either have failed one or more catheter ablations or prefer surgical therapy. With the advent of hybrid (combined catheter and surgical) approaches to ablation, the indications for stand-alone therapy may expand. 5
 

Medela products

We recommend the Basic suction pump. It is capable of reaching the vacuum levels [kPa] according to the publications referenced later. However, this is only a recommendation, the individual setting is the responsibility of the medical practitioner.

Benefits

Benefits of Basic suction pump for epicardial ablation:
Powerful but silent
  • Powerful drive unit is as quiet as a summer night. This helps the OR team concentrate on their delicate task.
  • State-of-the-art technology gives you reliable vacuum immediately.
User-centric design for ease of use
  • Clearly arranged operating elements on the front of the pump ensure an easy handling
  • Intuitive plug-in connections for collection system and accessories accelerate set-up time and facilitate handling.
  • Integrated foot on/off switch enables hands free operation.
Swiss engineering to prevent infections
  • Touch activated on/off switch and the housing with no gaps or grooves facilitate cleaning and minimize risk of infections.
  • Medela's DCS disposable liners integrate a bacteria/overflow protection filter.
  • As additional safety measure, the mechanical overflow set (Safety Set) protects the pump.
Designed to last a lifetime
  • Heavy-duty duty piston/cylinder technology offers exceptional durability shown by the 5-year warranty on the complete pump.
 

Suction levels

Between -500 mmHg and - 600 mmHg 0,3
 

References

0. Homepage Atricure.com and Instructions for Use
1. Vinay Badhwar et al, The Society of Thoracic Surgeons 2017 Clinical Practice Guidelines for the Surgical Treatment of Atrial Fibrillation. The Annals of Thoracic Surgery, 2017; 103: 329-41.
2. Ad et al.; Surgical ablation for atrial fibrillation in cardiac surgery. Innovations, vol 5, no 2, March/April 2010.
3. A New Vacuum-Assisted Probe for Minimally Invasive Radiofrequency Ablation, Stefano Bevilacqua, Ann Thorac Surg 2009;88:1317-1321
4. Total endoscopic ablation of atrial fibrillation, Espen Fengsrud et al, doi:10.1093/mmcts/mmv010 published online 1 June 2015
5. Christopher P. Lawrance et al, Surgical ablation for atrial fibrillation: techniques, indications, and results, Curr Opin Cardiol. 2015 January ; 30(1): 58–64.
6. https://stanfordhealthcare.org/medical-treatments/e/epicardial-ablation.html