title: Effectiveness and safety of simultaneous hybrid thoracoscopic and endocardial catheter ablation of lone atrial fibrillation.
abstract: BACKGROUND
  We evaluated the safety and effectiveness of the hybrid thoracoscopic endocardial epicardial technique for the treatment of lone atrial fibrillation.
  
  
  METHODS
  Between 2009 and 2012, a cohort of 78 consecutive patients (median age 60.5 years, 77% male) underwent ablation of atrial fibrillation (AF) as a stand-alone procedure using a thoracoscopic, hybrid epicardial-endocardial technique. All patients underwent continuous 7-day Holter monitoring at 3 months, 6 months, 1 year and yearly thereafter. All patients reached 1-year follow-up. Median follow-up was 24 months [interquartile range 12-36].
  
  
  RESULTS
  No death or conversion to cardiopulmonary bypass occurred. No patient demonstrated paralysis of the phrenic nerve. Overall, the incidence of perioperative complications was 8% (n=6). At the end of follow-up, sixty-eight patients (87%) were in sinus rhythm (SR) with no episode of AF, atrial flutter or atrial tachycardia lasting longer than 30 seconds and off antiarrhythmic drugs (ADD). Among patients with long-standing persistent AF, 15 (100%) were in SR and off AAD. Success rates were 82% (n=28) in persistent and 76% (n=22) in paroxysmal AF (P=0.08). No patient died and no thromboembolic/bleeding events or procedure-related complications occurred during the follow-up.
  
  
  CONCLUSIONS
  Thoracoscopic hybrid epicardial endocardial technique proved to be effective and safe in the treatment of LAF and to represent an important new suitable option to treat stand-alone AF. Our findings need to be confirmed by further larger studies.
authors: Cardiology Department, University Hospital, Maastricht, The Netherlands ;
authors: Laurent
authors: L
authors: Pison
authors: Cardiothoracic Surgery University Hospital, Maastricht, The Netherlands.
authors: Sandro
authors: S
authors: Gelsomino
authors: Cardiology Department, University Hospital, Maastricht, The Netherlands ;
authors: Fabiana
authors: F
authors: Lucà
authors: Cardiology Department, University Hospital, Maastricht, The Netherlands ;
authors: Orlando
authors: O
authors: Parise
authors: Cardiology Department, University Hospital, Maastricht, The Netherlands ;
authors: Jos G
authors: JG
authors: Maessen
authors: Cardiothoracic Surgery University Hospital, Maastricht, The Netherlands.
authors: Harry J G M
authors: HJ
authors: Crijns
authors: Cardiology Department, University Hospital, Maastricht, The Netherlands ;
authors: Mark
authors: M
authors: La Meir
keywords: Atrial fibrillation (AF); ablation; surgery