Completely thoracoscopic pulmonary vein isolation with ganglionic plexus ablation and left atrial appendage amputation for treatment of atrial fibrillation.
OBJECTIVE
Percutaneous catheter pulmonary vein isolation (PVI) has been the preferred choice for invasive treatment of symptomatic, drug-refractory lone atrial fibrillation (AF). Incomplete ablation lines, procedure-related morbidity and long-term success remain, however, a problem. A minimally invasive surgical approach can provide an attractive and secure alternative. Surgery offers an epicardial, bipolar approach under direct vision, but the invasiveness of surgery remains a problem. Therefore, we developed a completely thoracoscopic procedure. The objective of this study was to assess the feasibility, safety and effectiveness of a completely thoracoscopic surgical procedure to cure lone AF.


METHODS
Bilateral 'video-assisted thoracoscopy' was performed to isolate the bilateral pairs of pulmonary veins using bipolar RF-energy, to ablate the ganglionic plexus (GP) and to amputate the left atrial appendage. Preoperative, in-hospital and follow-up data were collected for our first 30 patients.


RESULTS
AF was paroxysmal in 63%, persistent in 27% and permanent in 10% of cases. The mean (+ or - SD) left atrial diameter was 42.1 + or - 7.4mm and the mean duration of AF was 79.0 + or - 63.9 months. Freedom from AF was obtained in 77% of the patients during a mean follow-up of 11.6 months. Forty-three percent of the patients had previously undergone a percutaneous PVI and were all free from AF during follow-up. Mean operation time was 137.4 + or - 24.7 min. All patients were extubated in the operating room and left the recovery room within 12 h. The mean hospital stay was 5.1 + or - 1.8 days. Two patients ultimately underwent a median sternotomy. No CVAs or pacemaker implantation were identified and none of the patients died.


CONCLUSIONS
We report our initial experience of a completely thoracoscopic PVI with GP-ablation and amputation of the left atrial appendage and demonstrate that the procedure is feasible, safe and effective for the treatment of lone AF.
Department of Cardio-Thoracic Surgery, St Antonius Hospital, Nieuwegein, The Netherlands.
Alaaddin
A
Yilmaz
Guillaume S C
GS
Geuzebroek
Bart P
BP
Van Putte
Lucas V A
LV
Boersma
Uday
U
Sonker
Jacques M T
JM
De Bakker
Wim-Jan
WJ
Van Boven
D000328:Adult; D000368:Aged; D020517:Atrial Appendage / Q000601:surgery*; D001281:Atrial Fibrillation / Q000601:surgery*; D017763:Autonomic Denervation / Q000379:methods; D017115:Catheter Ablation / Q000379:methods; D004812:Epidemiologic Methods; D005260:Female; D005725:Ganglia, Autonomic / Q000601:surgery*; D006801:Humans; D007432:Intraoperative Period; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods; D016896:Treatment Outcome