title: Long-term results of surgical minimally invasive pulmonary vein isolation for paroxysmal lone atrial fibrillation.
abstract: OBJECTIVE
  Transcatheter pulmonary vein ablation is the current treatment of choice for symptomatic drug-refractory atrial fibrillation (AF). Video-assisted surgical pulmonary vein isolation (sPVI) is an alternative therapy to percutaneous ablation for the treatment of AF. Long-term results of sPVI are currently unknown. The aim of this study was to report on the long-term efficacy and safety of sPVI in patients with paroxysmal AF.
  
  
  RESULTS
  The study design was observational and retrospective. From July 2005 to January 2011, 42 patients with drug-refractory paroxysmal AF underwent video-assisted sPVI in two different centres. Patients were eligible for sPVI when suffering from symptomatic, drug-refractory paroxysmal AF and they agreed to the alternative of sPVI. The median preoperative AF duration was 24 months (range 3-200). Success was defined as the absence of AF on 24 h or 96 h Holter monitoring during follow-up, off antiarrhythmic drugs (AAD). Adverse events and follow-up monitoring were based on the Heart Rhythm Society Consensus Statement 2012 for the catheter and surgical ablation of AF. Mean age was 55 ± 10 years, and 76% were males. After a mean follow-up of 5 years (SD 1.7), 69% of all patients were free from atrial arrhythmias without the use of AAD, and 83% with the use of AAD. Major peri-procedural adverse events occurred in four (9.5%) patients, no strokes or mortalities were registered during long-term follow-up.
  
  
  CONCLUSIONS
  This retrospective study shows that sPVI for the treatment of paroxysmal AF is effective and that the outcomes are maintained at long-term follow-up.
authors.affiliation: Cardio-Thoracic Surgery Department, Thoraxcenter, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands Cardiology Department, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands g.e.de.maat@umcg.nl.
authors.forename: Gijs E
authors.initials: GE
authors.lastname: De Maat
authors.affiliation: Cardiac Surgery Unit, San Raffaele University Hospital, Milan, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Pozzoli
authors.affiliation: Cardiology Department, Medisch Spectrum Twente, Enschede, The Netherlands.
authors.forename: Marcoen F
authors.initials: MF
authors.lastname: Scholten
authors.affiliation: Cardiology Department, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Isabelle C
authors.initials: IC
authors.lastname: Van Gelder
authors.affiliation: Cardiology Department, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Yuri
authors.initials: Y
authors.lastname: Blaauw
authors.affiliation: Cardiology Department, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Bart A
authors.initials: BA
authors.lastname: Mulder
authors.affiliation: Cardiology department, San Raffaele Scientific Institute, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Della Bella
authors.affiliation: Cardiac Surgery Unit, San Raffaele University Hospital, Milan, Italy.
authors.forename: Ottavio R
authors.initials: OR
authors.lastname: Alfieri
authors.affiliation: Cardiac Surgery Unit, San Raffaele University Hospital, Milan, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Benussi
authors.affiliation: Cardio-Thoracic Surgery Department, Thoraxcenter, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands.
authors.forename: Massimo A
authors.initials: MA
authors.lastname: Mariani
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D015716:Electrocardiography, Ambulatory; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012074:Remission Induction; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Minimally invasive surgery; Paroxysmal atrial fibrillation; Pulmonary vein isolation; Video-assisted thoracoscopy