Point: Minimally invasive bipolar radiofrequency ablation of lone atrial fibrillation: early multicenter results.
OBJECTIVE
The treatment of lone atrial fibrillation can be a minimally invasive procedure using bipolar radiofrequency ablation technologies. Our objectives were to report on the safety and early efficacy of this novel therapeutic modality.


METHODS
At 3 North American institutions between February 2005 and August 2007, 100 patients underwent minimally invasive bilateral pulmonary vein isolation, autonomic denervation, and left atrial appendage resection. The mean age was 65 +/- 11 years, and 70% were male. The median duration of atrial fibrillation was 5.0 years; atrial fibrillation was paroxysmal in 39 patients (39%), persistent in 29 patients (29%), and permanent in 32 patients (32%). Indications for surgery included failure of medical therapy or percutaneous ablation and severe symptoms. Mean follow-up was 13.6 +/- 8.2 months.


RESULTS
The mean operative time was 253 +/- 65 minutes, and the median hospital length of stay was 5 days. There were no intraoperative conversions and no mortality to report. Postoperative complications included pacemaker requirement in 5 patients (5%), phrenic nerve palsy in 3 patients (3%), hemothorax in 3 patients (3%), transient ischemic attack in 1 patient (1%), and pulmonary embolism in 1 patient (1%). At follow-up, 87% of patients were in normal sinus rhythm (paroxysmal 93%, persistent 96%, permanent 71%; P < .05); antiarrhythmic therapy was discontinued in 62% of patients, and anticoagulation therapy was discontinued in 65% of patients.


CONCLUSIONS
Minimally invasive bipolar radiofrequency ablation of lone atrial fibrillation is a safe and efficacious therapeutic option in selected patients. Further development is needed to reduce the rate of complications. Long-term prospective results are required to further validate this modality as a therapeutic option to treat lone atrial fibrillation.
Beyer
Erik
E
Scott and White Clinic, Temple, Texas, USA.
Lee
Richard
R
Lam
Buu-Khanh
BK
D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D013997:Time Factors