title: Minimally invasive surgical ablation of atrial fibrillation: six-month results.
abstract: BACKGROUND
  A minimally invasive surgery for treatment of atrial fibrillation was developed with bilateral pulmonary vein isolation, mapping, and ablation of the ganglionic plexi and excision of the left atrial appendage. A prospective multicenter registry was created to evaluate the outcomes.
  
  
  METHODS
  The procedure was performed through bilateral minithoracotomies with video assistance. It included bilateral pulmonary vein isolation with bipolar radiofrequency with documentation of conduction block, location of ganglionic plexi by high-frequency stimulation, and appropriate ablation and left atrial appendage exclusion/excision. Clinical follow-up at 6 months included monitoring with electrocardiogram, Holter, event monitor, or pacemaker interrogation.
  
  
  RESULTS
  One hundred fourteen patients with 60 (52.6%) paroxysmal, 32 (28.1%) persistent, and 22 (19.3%) long-standing persistent atrial fibrillations were treated. The mean age was 59.5 +/- 10.6 years, and 69.3% were men. The mean follow-up period was 204 +/- 41 days (median 195). There were 2 (1.8%) operative mortalities. At 6-month follow-up, with long-term monitoring, 52/60 (86.7%) patients with paroxysmal fibrillations were in normal sinus rhythm and 43/60 (71.7%) were both in normal sinus rhythm and off antiarrhythmic drugs. The patients with persistent atrial fibrillation had a lower success rate, with 18/32 (56.3%) being in normal sinus rhythm and 46.9% both in normal sinus rhythm and off antiarrhythmic drugs; for long-standing persistent cases, 11/22 (50%) were in normal sinus rhythm and 7/22 (31.9%) were also off antiarrhythmic drugs.
  
  
  CONCLUSIONS
  Minimally invasive atrial fibrillation surgery is an effective treatment of paroxysmal atrial fibrillation at 6 months. Continuous event monitoring is necessary to accurately assess treatment results. A more extensive lesion set seems to be required for treatment of persistent atrial fibrillation.
authors: Cardiopulmonary Research Science and Technology Institute, Dallas, Tex, USA. edgertonjr@aol.com
authors: James R
authors: JR
authors: Edgerton
authors: James H
authors: JH
authors: McClelland
authors: David
authors: D
authors: Duke
authors: Marc W
authors: MW
authors: Gerdisch
authors: Bryan M
authors: BM
authors: Steinberg
authors: Scott H
authors: SH
authors: Bronleewe
authors: Syma L
authors: SL
authors: Prince
authors: Morley A
authors: MA
authors: Herbert
authors: Shannon
authors: S
authors: Hoffman
authors: Michael J
authors: MJ
authors: Mack
mesh_terms: D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D020775:Thoracic Surgery, Video-Assisted