title: Thoracoscopic video-assisted pulmonary vein antrum isolation, ganglionated plexus ablation, and periprocedural confirmation of ablation lesions: first results of a hybrid surgical-electrophysiological approach for atrial fibrillation.
abstract: BACKGROUND
  Thoracoscopic pulmonary vein isolation (PVI) and ganglionated plexus ablation is a novel approach in the treatment of atrial fibrillation (AF). We hypothesize that meticulous electrophysiological confirmation of PVI results in fewer recurrences of AF during follow-up.
  
  
  RESULTS
  Surgery was performed through 3 ports bilaterally. Ganglionated plexi were localized and subsequently ablated. PVI was performed and entry and exit block was confirmed. Additional left atrial ablation lines were created and conduction block verified in patients with nonparoxysmal AF. The left atrial appendage was removed. Freedom of AF was assessed by ECGs and Holter monitoring every 3 months or during symptoms of arrhythmia. Antiarrhythmic drugs were discontinued after 3 months and oral anticoagulants were discontinued according to the guidelines. Thirty-one patients were treated (16 paroxysmal AF, 13 persistent AF, 2 long-standing persistent AF). Thirteen patients with nonparoxysmal received additional left atrial ablation lines. After 1 year, 19 of 22 patients (86%) had no recurrences of AF, atrial flutter, or atrial tachycardia and were not using antiarrhythmic drugs (11/12 paroxysmal, 7/9 persistent, and 1/1 long-standing persistent). Three patients had a sternotomy because of uncontrolled bleeding during thoracoscopic surgery. Four adverse events were 1 hemothorax, 1 pneumothorax, and 2 pneumonia. No thromboembolic complications or mortality occurred.
  
  
  CONCLUSIONS
  Thoracoscopic surgery with PVI and ganglionated plexus ablation for AF is a safe and successful procedure with a single procedure success rate of 86% at 1 year. Electrophysiological guided thorough PVI and additional left atrial ablation line creation presumably contributes in achieving a high success rate in the surgical treatment of AF.
authors.affiliation: Heart Failure Research Center, Department of Cardiology and Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Sébastien P J
authors.initials: SP
authors.lastname: Krul
authors.forename: Antoine H G
authors.initials: AH
authors.lastname: Driessen
authors.forename: Wim J
authors.initials: WJ
authors.lastname: van Boven
authors.forename: André C
authors.initials: AC
authors.lastname: Linnenbank
authors.forename: Guillaume S C
authors.initials: GS
authors.lastname: Geuzebroek
authors.forename: Warren M
authors.initials: WM
authors.lastname: Jackman
authors.forename: Arthur A M
authors.initials: AA
authors.lastname: Wilde
authors.forename: Jacques M T
authors.initials: JM
authors.lastname: de Bakker
authors.forename: Joris R
authors.initials: JR
authors.lastname: de Groot
mesh_terms: D000328:Adult; D000368:Aged; D020517:Atrial Appendage / Q000503:physiopathology / Q000601:surgery*; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D017763:Autonomic Denervation / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D015716:Electrocardiography, Ambulatory; D055724:Electrophysiological Phenomena; D005260:Female; D005500:Follow-Up Studies; D005725:Ganglia, Autonomic / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D013906:Thoracoscopy / Q000379:methods*; D016896:Treatment Outcome