title: Long-term results of ablation for isolated atrial fibrillation through a right minithoracotomy: toward a rational revision of treatment protocols.
abstract: OBJECTIVE
  Despite continued technical improvements, results of transcatheter radiofrequency ablation of atrial fibrillation may be suboptimal in some patient subgroups. Short-term follow-up of minimally invasive epicardial ablation of isolated atrial fibrillation has been encouraging.
  
  
  METHODS
  One hundred four patients with drug-refractory isolated atrial fibrillation underwent minimally invasive surgical ablation through right 3- to 4-cm minithoracotomy by isolation of pulmonary veins and were followed-up for an average of 17 months. Previous failed transcatheter ablation was not a criterion for this procedure. Antiarrhythmic drugs were continued until postoperative month 6, despite demonstration of stable sinus rhythm.
  
  
  RESULTS
  The procedure was confirmed to be safe (1 case of procedure-related morbidity, no operative deaths) and effective (89% overall freedom from recurrent arrhythmia at follow-up, 96% freedom from paroxysmal atrial fibrillation, 80% freedom from persisting type atrial fibrillation). Results tended to improve with the expansion of the surgical experience. Cox hazard regression and Kaplan-Meier analysis identified persisting type atrial fibrillation and enlarged left atrium as the major predictors of recurrent atrial fibrillation at follow-up. Health-related quality of life was confirmed to be improved at the end of the follow-up relative to baseline in most Medical Outcomes Study 36-Item Short-Form Health Survey domains.
  
  
  CONCLUSIONS
  Minimally invasive epicardial ablation of isolated atrial fibrillation yields stable, gradually improving results. Earlier surgical referral is justifiable after careful cardiologic work-up. To define the relative roles of minimally invasive ablation and transcatheter ablation, which may be considered in the future as alternative therapies, a randomized trial to compare these procedures is advisable.
authors.affiliation: Division of Cardiac Surgery, GVM Care & Research, Bari, Italy. gnasso@libero.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Nasso
authors.forename: Raffaele
authors.initials: R
authors.lastname: Bonifazi
authors.forename: Armando
authors.initials: A
authors.lastname: Del Prete
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Del Prete
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Lopriore
authors.forename: Francesco
authors.initials: F
authors.lastname: Bartolomucci
authors.forename: Antonio Maria
authors.initials: AM
authors.lastname: Calafiore
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Speziale
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D011788:Quality of Life; D012008:Recurrence; D013908:Thoracotomy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents