title: Long-term results of minimally invasive stand-alone bi-atrial surgical ablation with a bipolar ablation device for persistent and longstanding persistent AF: a single-center case series of 91 patients.
abstract: BACKGROUND
  Minimally invasive surgical treatment of lone atrial fibrillation (AF) is an alternative for AF that is refractory to medical treatment. We present long-term results of standalone surgical ablation of AF using a bipolar ablation device in 91 consecutive patients.
  
  
  METHODS
  This was an observational, retrospective study of 91 patients (77 % males; mean age, 53 ± 10 years [range, 23-75 years]) who underwent minimally invasive standalone surgical ablation of persistent and longstanding persistent AF using a bipolar ablation device from 2008 to 2014. Mean follow-up was 60 ± 21 months. The absence of arrhythmia was confirmed at 3, 6, and 12 months, and annually thereafter, with 24-hour Holter monitoring.
  
  
  RESULTS
  The mean duration of preoperative AF was 6.5 ± 5.4 years. Persistent AF was present in 86 % of patients and longstanding persistent AF in 14 %. Mean left atrial diameter was 4.3 ± 0.8 cm. There were two postoperative strokes (2 %) and three conversions to median sternotomy (3 %). Permanent pacemakers were implanted in six (7 %) patients. There were no intra- or postoperative deaths. At 1, 2, 3, 4, and 5 years postoperatively, freedom from AF was 59, 45, 41, 38, and 38 % of patients, respectively. The failure to achieve pulmonary vein isolation was the only independent predictor of long-term recurrence of AF (HR -3 [95 % CI 1,858 to 8,586], p = 0,001). There was a tendency towards higher rates of SR at long term follow up in patients with pulmonary vein isolation if division of ligament of Marshall was performed (HR - 2 [95 % CI 0.987 to 4,202], p = 0,067).
  
  
  CONCLUSIONS
  In the present series, the efficacy of epicardial surgical ablation was similar to that reported previously. The rate of arrhythmia recurrence increased over time. Achieving pulmonary vein isolation is essential to AF elimination. The division of ligament of Marshall could contribute to improved rates of SR restoration in patients with persistent or long-standing persistent AF if PVI is achieved.
authors.affiliation: Department of Cardiovascular Medicine, Vilnius University, Universiteto street 3, Vilnius, Lithuania. janvilius@yahoo.com.
authors.forename: Vilius
authors.initials: V
authors.lastname: Janusauskas
authors.affiliation: Department of Cardiovascular Medicine, Vilnius University, Universiteto street 3, Vilnius, Lithuania. l.puodziukaite@gmail.com.
authors.forename: Lina
authors.initials: L
authors.lastname: Puodziukaite
authors.affiliation: Department of Cardiovascular Medicine, Vilnius University, Universiteto street 3, Vilnius, Lithuania. vyte.maneikiene@santa.lt.
authors.forename: Vyte Valerija
authors.initials: VV
authors.lastname: Maneikiene
authors.affiliation: Department of Cardiovascular Medicine, Vilnius University, Universiteto street 3, Vilnius, Lithuania. gitana.zuoziene@santa.lt.
authors.forename: Gitana
authors.initials: G
authors.lastname: Zuoziene
authors.affiliation: Department of Cardiovascular Medicine, Vilnius University, Universiteto street 3, Vilnius, Lithuania. greta.radauskaite@santa.lt.
authors.forename: Greta
authors.initials: G
authors.lastname: Radauskaite
authors.affiliation: Department of Cardiovascular Medicine, Vilnius University, Universiteto street 3, Vilnius, Lithuania. greta.burneikaite@santa.lt.
authors.forename: Greta
authors.initials: G
authors.lastname: Burneikaite
authors.affiliation: Centre of Anesthesia, Intensive Care, and Pain Management, Department of Intensive Care, Vilnius University, Universiteto street 3, Vilnius, Lithuania. robertas.samalavicius@santa.lt.
authors.forename: Robertas Stasys
authors.initials: RS
authors.lastname: Samalavicius
authors.affiliation: Department of Cardiovascular Medicine, Vilnius University, Universiteto street 3, Vilnius, Lithuania. sigita.aidietiene@santa.lt.
authors.forename: Sigita
authors.initials: S
authors.lastname: Aidietiene
authors.affiliation: Department of Cardiovascular Medicine, Vilnius University, Universiteto street 3, Vilnius, Lithuania. kestutis.rucinskas@santa.lt.
authors.forename: Kestutis
authors.initials: K
authors.lastname: Rucinskas
authors.affiliation: Department of Cardiovascular Medicine, Vilnius University, Universiteto street 3, Vilnius, Lithuania. audrius.aidietis@santa.lt.
authors.forename: Audrius
authors.initials: A
authors.lastname: Aidietis
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D015716:Electrocardiography, Ambulatory; D005260:Female; D006325:Heart Atria / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D011667:Pulmonary Veins / Q000601:surgery; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult
references.citation: Circ Res. 1972 Jul;31(1):18-35
references.pmid: 5038734
references.citation: J Thorac Cardiovasc Surg. 2006 May;131(5):1029-35
references.pmid: 16678586
references.citation: J Cardiovasc Electrophysiol. 2013 Oct;24(10):1092-100
references.pmid: 23790106
references.citation: PLoS One. 2013;8(11):e79755
references.pmid: 24244556
references.citation: Ann Thorac Surg. 2013 Sep;96(3):792-8; discussion 798-9
references.pmid: 23891410
references.citation: J Am Coll Cardiol. 2012 Nov 6;60(19):1921-9
references.pmid: 23062545
references.citation: Europace. 2012 Apr;14(4):528-606
references.pmid: 22389422
references.citation: Eur J Cardiothorac Surg. 2015 Oct;48(4):531-40; discussion 540-1
references.pmid: 25567961
references.citation: Europace. 2015 May;17(5):747-52
references.pmid: 25600767
references.citation: Europace. 2015 Jan;17(1):38-47
references.pmid: 25336669
references.citation: J Thorac Cardiovasc Surg. 2014 Nov;148(5):2161-6
references.pmid: 24667024
references.citation: Circulation. 2014 Dec 2;130(23):2071-104
references.pmid: 24682348
references.citation: J Am Coll Cardiol. 2006 Jun 20;47(12):2504-12
references.pmid: 16781381
references.citation: J Cardiovasc Electrophysiol. 2006 Aug;17(8):839-46
references.pmid: 16903962
references.citation: J Cardiovasc Electrophysiol. 2006 Oct;17(10):1062-7
references.pmid: 16800853
references.citation: Ann Thorac Surg. 2007 Mar;83(3):1225-30
references.pmid: 17307507
references.citation: Rev Port Cardiol. 2007 Apr;26(4):383-446
references.pmid: 17695733
references.citation: Eur Heart J. 2007 Nov;28(22):2803-17
references.pmid: 17897924
references.citation: Heart Rhythm. 2009 Dec;6(12 Suppl):S35-40
references.pmid: 19959141
references.citation: Europace. 2010 Oct;12(10):1360-420
references.pmid: 20876603
references.citation: Ann Thorac Surg. 2011 Oct;92(4):1397-404; discussion 1404-5
references.pmid: 21958788
references.citation: Heart Surg Forum. 2011 Oct;14(5):E271-5
references.pmid: 21997647
references.citation: Circ Arrhythm Electrophysiol. 2012 Feb;5(1):8-14
references.pmid: 22095640