Minimally invasive pulmonary vein isolation and partial autonomic denervation for surgical treatment of atrial fibrillation.
OBJECTIVE
It was our goal to determine the efficacy of a minimally invasive surgical approach to the treatment of atrial fibrillation that combines pulmonary vein antral isolation with targeted partial autonomic denervation.


METHODS
Eighty-three patients underwent video-assisted bilateral pulmonary vein antral electrical isolation with confirmation of block and partial autonomic denervation. Sixty-two (41 paroxysmal, 21 persistent/long-standing persistent) patients had a follow-up of 6 months or greater. Fifty-seven of these patients had a long-term rhythm monitor at 6 months (39 paroxysmal, 18 persistent/long-standing persistent).


RESULTS
Success was defined as no episodes of atrial fibrillation greater than 15 s duration on long-term monitoring. Treatment was successful in 32 of 39 (82.1%) patients with paroxysmal atrial fibrillation and 10 of 18 (55.6%) with persistent/long-standing persistent atrial fibrillation.


CONCLUSIONS
Early data suggest that pulmonary vein electrical isolation combined with targeted partial autonomic denervation is a safe and efficacious approach for the treatment of paroxysmal atrial fibrillation. Techniques are being developed for the minimally invasive surgical treatment of persistent and long-standing persistent atrial fibrillation from an epicardial approach.
Edgerton
James R
JR
Cardiopulmonary Research Science and Technology Institute, Dallas, TX, USA. edgertonjr@aol.com
Jackman
Warren M
WM
Mack
Michael J
MJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000601:surgery*; D017763:Autonomic Denervation / Q000379:methods*; D005260:Female; D006329:Heart Conduction System / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D011667:Pulmonary Veins / Q000601:surgery*; D020708:Thoracoscopes; D013906:Thoracoscopy / Q000379:methods*; D016896:Treatment Outcome