Description: Aims Despite its proven efficacy, the Cox-Maze III procedure did not gain widespread acceptance for the treatment of stand-alone atrial fibrillation (SA-AF) because of its complexity and technical difficulty. Surgical ablation for SA-AF can now be successfully performed utilizing minimally invasive surgery (MIS). This study provides an overview of state-of-the-art MIS for the treatment of SA-AF. Methods and results Studies selected for this review were identified on PUBMED and exclusion and inclusion criteria were applied to select the publication to be screened. Twenty-eight studies were included; 27 (96.4%) were observational in nature whereas 1 was prospective non-randomized. The total number of patients was 1051 (range 14–114). Mean age ranged from 45.3 to 67.1 years. Suboptimal results were obtained when employing microwave and high focused ultrasound energies. In contrast, MIS ablation of SA-AF achieved satisfactory 1-year results when the bipolar radiofrequency was employed as energy source, with antiarrhythmic drug-free success rate comparable to percutaneous catheter ablation (PCA). The success rate in paroxysmal was even higher than in PCA. In contrast, ganglionated plexi ablation and left atrial appendage removal seem not to influence the recurrence of AF and the occurrence of postoperative thromboembolic events. Conclusion Minimally invasive surgery ablation of SA-AF achieved satisfactory 1-year results when the bipolar radiofrequency was employed. Nevertheless, the relatively high complication rate reported suggest that such techniques require further refinement. Finally, the preliminary results of the hybrid approach are promising but they need to be confirmed.

Description: Aims To assess the results and impact of lesion set and surgical technique on long-term success of surgical ablation during mitral surgery. Methods and results The patient population consisted of 685 subjects with persistent and long-standing persistent atrial fibrillation (AF) undergoing cardiac surgery for mitral valve disease as the primary indication and concomitant ablation between January 2003 and January 2012 at three institutions. One hundred and sixty-six underwent unipolar (24.2%), 371 (54.2%) bipolar, and 148 (21.6%) had combined ablation. Median follow-up was 58.4 months (interquartile range 43.3–67.9). To appropriately account for death, a competing risk model was employed to identify predictors of cumulative incidence of recurrent AF among lesion set and surgical techniques. Eight-year freedom from recurrent arrhythmia without antiarrhythmic drugs was 0.60 ± 0.02. Success rate was higher using bipolar radiofrequency (RF) ( P 〈 0.001), after performing mitral isthmus line ( P = 0.003) and following the biatrial technique ( P 〈 0.001). Competing risk regression revealed that use of unipolar RF [sub-hazard ratio (SHR) 2.41 (1.52–3.43), P 〈 0.001], combined unipolar/bipolar ablation [SHR 1.93 (0.89–2.57), P = 0.003] and the absence of right atrial ablation [SHR 2.79 (1.27–3.48), P 〈 0.001] were predictors of cumulative incidence of long-term recurrence. Conclusions Our experience suggests that the use of bipolar clamp improves long-term results in surgical treatment of AF and that right-sided ablation should be routinely added. Randomized studies are necessary to confirm our findings.

Description: The PRISMA satellite mission launched on March 22nd, 2019 is one of the latest spaceborne imaging spectroscopy mission for Earth Observation. The PRISMA satellite comprises a high-spectral resolution VNIR-SWIR imaging spectrometer and a panchromatic camera. In summer 2019, first operations during the commissioning phase were mainly devoted to acquisitions in specific areas for evaluating instrument functioning, in-flight performance, and mission data product accuracy. A field and airborne campaign was carried out over an agriculture area in Italy to collect in-situ multi-source spectroscopy measurements at different scales simultaneously with PRISMA. The spectral, radiometric and spatial performance of PRISMA Level 1 Top-Of-Atmosphere radiance (LTOA) product were analyzed. The in-situ surface reflectance measurements over different landcovers were propagated to LTOA using MODTRAN5 radiative transfer simulations and compared with satellite observations. Overall, this work offers a first quantitative evaluation about the PRISMA mission performance and imaging spectroscopy LTOA data product consistency. Our results show that the spectral smile is less than 5 nm, the average spectral resolution is 13 nm and 11 nm (VNIR and SWIR respectively) and it varies ±2 nm across track. The radiometric comparison between PRISMA and field/airborne spectroscopy shows a difference lower than 5% for NIR and SWIR, whereas it is included in the 2–7% range in the VIS. The estimated instrument signal to noise ratio (SNR) is ≈400–500 in the NIR and part of the SWIR (〈1300 nm), lower SNR values were found at shorter (〈700 nm) and longer wavelengths (〉1600 nm). The VNIR-to-SWIR spatial co-registration error is below 8 m and the spatial resolution is 37.11 m and 38.38 m for VNIR and SWIR respectively. The results are in-line with the expectations and mission requirements and indicate that acquired images are suitable for further scientific applications. However, this first assessment is based on data from a rural area and this cannot be fully exhaustive. Further studies are needed to confirm the performance for other land cover types like snow, inland and coastal waters, deserts or urban areas.