Minimally invasive pulmonary vein isolation and partial autonomic denervation for surgical treatment of atrial fibrillation.
BACKGROUND
We seek to demonstrate the rationale and efficacy of a minimally invasive surgical approach to the treatment of atrial fibrillation (AF) that combines pulmonary vein antral isolation with targeted partial autonomic denervation.


METHODS
The literature supporting the rationale of this approach is reviewed. Seventy-four patients underwent video-assisted bilateral pulmonary vein antral isolation with confirmation of block and partial autonomic denervation with follow-up of 6 months or greater and have a long-term rhythm monitor at 6 months.


RESULTS
Success was defined as no episodes greater than 15 seconds of AF on long-term monitoring. Treatment was successful in 83.7% of patients with paroxysmal AF and 56.5% of patients with persistent/long-standing persistent AF.


CONCLUSIONS
There are evidence-based data that support both pulmonary vein electrical isolation and targeted partial autonomic denervation in the treatment of AF. These techniques can be combined in a minimally invasive surgical approach. Early data suggest this is a safe and efficacious approach for the treatment of paroxysmal AF. Techniques are being developed for the minimally invasive surgical treatment of persistent AF from an epicardial approach.
Cardiopulmonary Research Science and Technology Institute, Dallas, Texas, USA. edgertonjr@aol.com
James R
JR
Edgerton
Zachary J
ZJ
Edgerton
Tara
T
Weaver
Kellie
K
Reed
Syma
S
Prince
Morley A
MA
Herbert
Michael J
MJ
Mack
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D017763:Autonomic Denervation / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011667:Pulmonary Veins / Q000601:surgery*; D018570:Risk Assessment; D012720:Severity of Illness Index; D015996:Survival Rate; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods; D016896:Treatment Outcome