Minimally invasive radiofrequency ablation of lone atrial fibrillation by monolateral right minithoracotomy: operative and early follow-up results.
BACKGROUND
Although an increasing number of symptomatic patients with atrial fibrillation (AF) are being treated with percutaneous radiofrequency ablation, the actual long-term success rate of this procedure remains uncertain. The increasing availability of minimally invasive techniques has made surgery progressively more appealing, especially because of its superior capacity to create transmural lesions.


METHODS
In a group of 46 patients with paroxysmal or persistent "lone" AF, who were refractory to medical treatment or had arrhythmia recurrences after a transcatheter procedure, we performed epicardial radiofrequency ablation by a minimally invasive, monolateral thoracoscopic approach. Mean operative time was 85 +/- 35 minutes, and intensive care unit and hospital stays were, respectively, 18.7 +/- 5.1 hours and 4.1 +/- 1.4 days. There were no deaths and only 1 serious complication due to severe bleeding requiring conversion to median sternotomy.


RESULTS
At the 6-month follow-up (Holter monitoring), 40 patients (87%) were in stable sinus rhythm. Of the 6 recurrences that we observed, 5 occurred in patients with persistent AF and 1 in a patient with paroxysmal AF (p < 0.01).


CONCLUSIONS
Minimally invasive monolateral thoracoscopic radiofrequency ablation is safe and apparently effective. If these findings are confirmed on larger populations followed for longer periods, this procedure may become a viable proposal for treating refractory lone AF.
Speziale
Giuseppe
G
Cardiovascular Department, GVM Hospitals Care and Research Foundation, Bari, Italy.
Bonifazi
Raffaele
R
Nasso
Giuseppe
G
Bartolomucci
Francesco
F
Caldarola
Pasquale
P
Fattouch
Khalil
K
Martines
Giuseppe
G
Tavazzi
Luigi
L
Chierchia
Sergio Luigi
SL
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D011667:Pulmonary Veins / Q000601:surgery*; D013908:Thoracotomy; D016896:Treatment Outcome; D055815:Young Adult