title: Thoracoscopic radiofrequency ablation for lone atrial fibrillation: box-lesion technique.
abstract: BACKGROUND
  We report the feasibility and outcomes of box-lesion ablation technique to treat stand-alone atrial fibrillation (AF).
  
  
  METHODS
  There were 41 patients with a mean age of 57.6 ± 8.0 years who underwent bilateral totally thoracoscopic ablation of symptomatic paroxysmal AF (n = 24; 58.5%), persistent AF (n = 9; 22.0%), or long-standing persistent AF (n = 8; 19.5%). The box-lesion procedure included bilateral pulmonary vein and left atrial posterior wall ablation using irrigated bipolar radiofrequency with documentation of conduction block.
  
  
  RESULTS
  There were no intra- or perioperative ablation-related complications. There was no operative mortality, no myocardial infarction, and no stroke. Skin-to-skin procedure time was 119.5 ± 23.7 minutes and the postoperative average length of stay was 7.4 ± 2.5 days. At discharge, 38 patients (93%) were in sinus rhythm. Median follow-up time was 641 days (ranges, 185-1636 days). At six months postsurgery, 31 patients of 41 (76%) were free from AF without the need of antiarrhythmic drugs. One-year success rate was 73% (off antiarrhythmic drugs). Eight patients (19.5%) underwent catheter reablation. Thirty-six patients (90%) were in sinus rhythm at six months after the last performed ablation (surgical ablation or catheter reablation). At 12 months follow-up, 61% patients discontinued oral anticoagulant therapy.
  
  
  CONCLUSIONS
  The thoracoscopic box-lesion ablation procedure is a safe, effective, and minimally invasive method for the treatment of isolated (lone) AF. This procedure provided excellent short-term freedom from AF.
authors: Department of Cardiac Surgery, Charles University in Prague, Faculty of Medicine and University Hospital in Hradec Kralove, Hradec Kralove, Czech Republic.
authors: Marek
authors: M
authors: Pojar
authors: Jan
authors: J
authors: Vojacek
authors: Ludek
authors: L
authors: Haman
authors: Petr
authors: P
authors: Parizek
authors: Nedal
authors: N
authors: Omran
authors: Martin
authors: M
authors: Vobornik
authors: Jan
authors: J
authors: Harrer
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography; D015716:Electrocardiography, Ambulatory; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000601:surgery; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011667:Pulmonary Veins / Q000601:surgery; D013906:Thoracoscopy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome