title: Electrophysiological findings after surgical thoracoscopic atrial fibrillation ablation.
abstract: Hybrid ablation (a combination of thoracoscopic epicardial ablation and catheter ablation) has become a new technique for atrial fibrillation treatment.
  
  
  
  The goal of this study was to evaluate the success and electrophysiological follow-up after using the COBRA Fusion device to deliver a circumferential lesion set anterior to the pulmonary veins in an attempt to isolate the posterior left atrium (box isolation).
  
  
  
  Surgical ablation was carried out via a thoracoscopic approach using the COBRA Fusion radiofrequency catheter. An electrophysiology study was done 2-3 months later to verify box isolation (and to complete it, if needed) and to perform right-sided isthmus ablation. Fat thickness along the presumed box lesion line was measured using preprocedural computed tomography.
  
  
  
  Thirty patients (mean age 60.0 ± 11.6 years; 22 men; 8 with long-standing persistent AF and 22 with persistent atrial fibrillation) were enrolled. The duration of the EP study was 216.3 ± 64.2 minutes. Box isolation, based on the EP study, was complete in 12 patients (40%) and incomplete in 18 patients (60%). Successful box isolation was achieved with catheter ablation in 16 of 18 patients (89%). A total of 39 gaps in these 16 patients were identified. Typical gap locations were the anterior-superior part of the superior pulmonary veins and the roofline. Fat thickness along the roofline was substantially higher than that along the inferior line (4.58 ± 1.61 mm vs 2.37 ± 0.76 mm; P < .001).
  
  
  
  There is a relatively low rate of complete isolation using the COBRA catheter ablation system. The superior line and anterior parts of superior pulmonary veins have most conduction gaps.
authors.affiliation: IIIrd Internal - Cardiology Clinic. Electronic address: pavel.osmancik@gmail.com.
authors.forename: Pavel
authors.initials: P
authors.lastname: Osmancik
authors.affiliation: Clinic of Cardiac Surgery, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic.
authors.forename: Petr
authors.initials: P
authors.lastname: Budera
authors.affiliation: IIIrd Internal - Cardiology Clinic.
authors.forename: Jana
authors.initials: J
authors.lastname: Zdarska
authors.affiliation: IIIrd Internal - Cardiology Clinic.
authors.forename: Dalibor
authors.initials: D
authors.lastname: Herman
authors.affiliation: IIIrd Internal - Cardiology Clinic.
authors.forename: Robert
authors.initials: R
authors.lastname: Petr
authors.affiliation: Clinic of Cardiac Surgery, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic.
authors.forename: Zbynek
authors.initials: Z
authors.lastname: Straka
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D022062:Electrophysiologic Techniques, Cardiac / Q000379:methods; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000601:surgery; D013906:Thoracoscopy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Box lesion; Hybrid ablation; Long-standing persistent atrial fibrillation; Persistent atrial fibrillation; Thoracoscopic ablation