title: Toward a definitive, totally thoracoscopic procedure for atrial fibrillation.
abstract: OBJECTIVE
  Evolution of anti-arrhythmia surgery beyond the Cox maze III has been hampered by the difficulty in implementing a complete lesion set in a truly minimally invasive approach. In this study, we introduce a true port-access procedure that addresses both autonomic and anatomic sources of atrial fibrillation, with real-time verification of all technical endpoints.
  
  
  METHODS
  A total of 32 patients with persistent or longstanding persistent atrial fibrillation underwent the totally thoracoscopic anti-arrhythmia procedure incorporating pulmonary vein isolation, mapping of epicardial autonomics, extended linear ablations across critical segments of atrial substrate, and ligation of the left atrial appendage. All aspects of the procedure were confirmed with intraoperative electrophysiologic testing.
  
  
  RESULTS
  With 1 week of continuous rhythm surveillance at 3, 6, and 13 months postoperatively in all patients, 21 of 24 patients with 6-month follow-up are in sinus rhythm with no anti-arrhythmia medications.
  
  
  CONCLUSIONS
  An anti-arrhythmia operation that is highly effective in patients with advanced forms of atrial fibrillation can be safely performed through a totally port-access approach.
authors.affiliation: Ohio State University Department of Surgery, Division of Cardiothoracic Surgery, Columbus, Ohio, USA.
authors.forename: John
authors.initials: J
authors.lastname: Sirak
authors.forename: Danielle
authors.initials: D
authors.lastname: Jones
authors.forename: Benjamin
authors.initials: B
authors.lastname: Sun
authors.forename: Chittoor
authors.initials: C
authors.lastname: Sai-Sudhakar
authors.forename: Juan
authors.initials: J
authors.lastname: Crestanello
authors.forename: Michael
authors.initials: M
authors.lastname: Firstenberg
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D015331:Cohort Studies; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013906:Thoracoscopy / Q000379:methods* / Q000639:trends; D016896:Treatment Outcome