En bloc exclusion of the pulmonary vein region in the pig using off pump, beating, intra-cardiac surgery: a pilot study of minimally invasive surgery for atrial fibrillation.
BACKGROUND
Off-pump, closed, beating heart, minimally-invasive surgery in patients with lone atrial fibrillation (AF) must be effective to become the preferred alternative to catheter ablation. Because of the inherent anatomical limitations of the epicardial access, we explored the feasibility of an intracardiac approach.


METHODS
We report an acute study of en bloc, cryo-exclusion of the pulmonary vein region in 7 pigs. The left atrial appendage (LAA) was approached via a left thoracotomy. Electrodes were attached to the posterior wall of the left atrium (LPA) and right atrial appendage (RAA) for pacing and electrophysiological monitoring. A modified Surgifrost probe was introduced via the LAA and positioned using transesophageal (TEE) and intracardiac (ICE) echocardiographic guidance to generate encircling cryolesions (3 minutes, -105 degrees C) of the pulmonary vein region.


RESULTS
A complete two-way block was achieved in 6 pigs and an incomplete block in 1. The excluded segment had very slow idiosyncratic rhythm or was electrically silent. In all pigs before isolation, sustained AF was inducible with the most rapid rhythms and fractionated electrograms recorded from the LA. While sustained AF was induced before exclusion, it was not after isolation in either the exclude or non-excluded segments. All tissue samples taken along the encircling cryolesions had transmural cryolesions on pathological examination.


CONCLUSIONS
We conclude that off-pump, closed heart, beating, intracardiac AF surgery is feasible, reliable and can duplicate the accuracy and precision of the open-heart approach. However, further developments are needed to make this novel approach an alternative to current approaches for catheter ablation.
Guiraudon
Gerard M
GM
Canadian Surgical Technologies and Advance Robotics, Lawson Health Research Institute, London, Ontario, Canada. gguiraud@uwo.ca
Jones
Douglas L
DL
Skanes
Allan C
AC
Bainbridge
Daniel
D
Guiraudon
Colette M
CM
Jensen
Steen M
SM
Yuan
Xiaping
X
Drangova
Maria
M
Peters
Terry M
TM
D000818:Animals; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000601:surgery*; D047549:Coronary Artery Bypass, Off-Pump / Q000379:methods*; D003452:Cryosurgery / Q000379:methods; D004195:Disease Models, Animal; D004452:Echocardiography / Q000379:methods; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000473:pathology; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D010865:Pilot Projects; D011667:Pulmonary Veins / Q000601:surgery*; D013552:Swine; D016896:Treatment Outcome