A video-assisted thoracoscopic technique to encircle the four pulmonary veins: a new surgical intervention for atrial fibrillation ablation.
BACKGROUND
Atrial fibrillation (AF) is the most common of the so-called benign arrhythmias. It affects not only life expectancy but also quality of life. Until recently, surgeons have most often encountered AF in association with ischemic or valvular disease but rarely as lone atrial fibrillation (LAF). For the subset of LAF patients, a minimally invasive procedure is recommended.


METHODS
Using an animal model, we have developed a video-assisted thoracoscopic approach to atrial ablation whereby the ablation is performed encircling the four pulmonary veins as through a median sternotomy.


RESULTS
Fifteen animals were used, and in 5 a complete encircling of the pulmonary veins was accomplished using the thoracoscopic approach.


CONCLUSIONS
Video-assisted thoracoscopy is a feasible and safe approach for epicardial pulmonary vein ablation. This technique offers the option of surgery to a class of patients who are resistant to medical therapy but for whom the presence of LAF contraindicates the open chest approach.
Manasse
Eric
E
Department of Cardiac Surgery, Istituto Clinico Humanitas, Universita degli Studi di Milano, Via Giovannino de Grassi 17, Milan 20123, Italy. emanasse@inwind.it
Infante
Maurizio
M
Ghiselli
Simone
S
Cariboni
Umberto
U
Alloisio
Marco
M
Barbone
Alessandro
A
Addis
Alessandro
A
Gallotti
Roberto
R
D000818:Animals; D001281:Atrial Fibrillation / Q000601:surgery*; D004195:Disease Models, Animal; D011667:Pulmonary Veins / Q000601:surgery*; D012756:Sheep; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*