title: Surgical minimally invasive pulmonary vein isolation for lone atrial fibrillation: midterm results of a multicenter study.
abstract: OBJECTIVE
  Minimally invasive surgical pulmonary vein isolation (SMI-PVI) is an emerging therapy for the treatment of symptomatic drug-refractory atrial fibrillation (AF). Nevertheless, the midterm and long-term results of SMI-PVI remain unknown. The aim of this retrospective multicenter study was to report on midterm efficacy and safety of SMI-PVI.
  
  
  METHODS
  The study design was retrospective, multicentric, and observational. From July 2005 to November 2011, a total of 86 patients with drug-refractory paroxysmal or persistent AF underwent SMI-PVI in three centers. Patients were eligible for SMI-PVI if they had symptomatic, drug-refractory AF or after failed transcatheter pulmonary vein isolation. Success was defined as absence of AF on 24- or 96-hour Holter monitoring during follow-up, in the absence of antiarrhythmic drugs (AADs).
  
  
  RESULTS
  The mean ± SD age was 54 ± 11 years, and 78% were men. The median AF duration was 30 months (range, 2-203); paroxysmal AF was present in 86% of the patients, persistent in 14%. Fifteen patients (17%) underwent previous transcatheter ablations. After a median follow-up of 24 months (range, 6-78), 72% of all patients were free from atrial arrhythmias without the use of AADs. With AADs, this was 83%. Major perioperative adverse events occurred in 7 patients (8%).
  
  
  CONCLUSIONS
  This retrospective multicenter study shows that SMI-PVI is effective at a median follow-up of 24 months for the treatment of mostly paroxysmal drug-refractory AF. Perioperative adverse events do remain a point of caution.
authors.affiliation: From the *Department of Cardio-Thoracic Surgery, and †Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; ‡Cardiac Surgery Unit, San Raffaele Scientific Institute, Milan, Italy; §Department of Cardiology, Medisch Spectrum Twente, Enschede, The Netherlands; and ∥Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Gijs E
authors.initials: GE
authors.lastname: De Maat
authors.forename: Alberto
authors.initials: A
authors.lastname: Pozzoli
authors.forename: Marcoen F
authors.initials: MF
authors.lastname: Scholten
authors.forename: Hans L
authors.initials: HL
authors.lastname: Hillege
authors.forename: Isabelle C
authors.initials: IC
authors.lastname: Van Gelder
authors.forename: Ottavio R
authors.initials: OR
authors.lastname: Alfieri
authors.forename: Stefano
authors.initials: S
authors.lastname: Benussi
authors.forename: Massimo A
authors.initials: MA
authors.lastname: Mariani
mesh_terms: D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D015716:Electrocardiography, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000601:surgery*; D012189:Retrospective Studies; D013614:Tachycardia, Paroxysmal / Q000503:physiopathology / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*