title: A novel "box lesion" minimally invasive totally thoracoscopic surgical ablation for atrial fibrillation.
abstract: BACKGROUND
  Minimally invasive surgical ablation is an emerging alternative method to catheter ablation and the full surgical maze procedure for nonpharmacologic treatment of atrial fibrillation (AF). We present a totally thoracoscopic "box lesion" radiofrequency ablation procedure in patients with paroxysmal or persistent AF.
  
  
  METHODS
  From June 2011 to October 2012, 14 patients with lone paroxysmal (n = 7) or persistent AF (n = 7) were enrolled in this study. Procedures were performed through 3 5-12 mm holes on each side of the chest wall. A bipolar ablation device was used to create a box lesion in the posterior wall of the left atrium that encircled the 4 pulmonary veins (achieving bilateral pulmonary vein/posterior left atrial wall isolation). Perioperative complications were recorded for all patients. Freedom from AF was assessed by 24-hour Holter monitoring every 3 months or during symptoms of arrhythmia.
  
  
  RESULTS
  The ablation was successfully performed in all patients, with median operation time of 128 minutes (range, 45 to 180 minutes). No operative mortality or morbidity were noted during the study period. Freedom from AF was achieved in 12 patients (85.7%) during follow-up (median follow-up 9 months). One patient with persistent AF was shifted to paroxysmal AF. No atrial flutter or atrial tachycardia was noted during the follow-up.
  
  
  CONCLUSIONS
  These early results show that totally thoracoscopic surgical ablation using a unique "box lesion" procedure for persistent or paroxysmal AF is a feasible and effective method with good short-term results. Further study is necessary to validate this result.
authors.affiliation: Department of Cardiovascular Surgery, West China Hospital, Sichuan University, People's Republic of China.
authors.forename: Qiu Zhe
authors.initials: QZ
authors.lastname: Guo
authors.forename: Da
authors.initials: D
authors.lastname: Zhu
authors.forename: Zhi Xuan
authors.initials: ZX
authors.lastname: Bai
authors.forename: Jun
authors.initials: J
authors.lastname: Shi
authors.forename: Ying Kang
authors.initials: YK
authors.lastname: Shi
authors.forename: Ying Qiang
authors.initials: YQ
authors.lastname: Guo
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013906:Thoracoscopy