Vigneshwar Kasirajan, MD, and Kenneth Ellenbogen, MD, are jointly engaged in a trial for a procedure that may bring new hope for patients with chronic atrial fibrillation that has not responded to medication or previous ablations.
According to Kasirajan, Dual Epicardial Endocardial Persistent (DEEP)’s two-step therapy targets the areas of erratic heartbeat from both inside and outside the heart. “Patients first undergo a surgical ablation of the left upper chamber of the heart from the outside using a minimally invasive closed-chest procedure. Then 90 to 120 days later, they undergo a catheter-based mapping inside the heart to see if the condition still exists,” he says. If it does, “the patient will then receive an EP ablation, from the inside of the heart.”
Kasirajan, chair of Surgery, and Ellenbogen, chair of Cardiology for VCU Health, have conducted the dual procedure since 2006; this particular trial explores the use of the AtriCure bipolar system, a device for performing the ablations outside the heart along with other approved devices for ablation inside the heart.
“By combining both procedures, we hope for higher success rates over the long term.”
“For persistent afib, particularly if the patient has failed medications and the condition has lasted over one year, the EP-only ablation success rate is about
30–50%. The surgical success is also in the 30–50% range,” he says. “By combining both procedures, we hope for higher success rates over the long term.”