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Thoracoscopic Radiofrequency Ablation for Lone Atrial Fibrillation: Box‐Lesion Technique
Author(s) -
Pojar Marek,
Vojacek Jan,
Haman Ludek,
Parizek Petr,
Omran Nedal,
Vobornik Martin,
Harrer Jan
Publication year - 2014
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.12409
Subject(s) - medicine , ablation , atrial fibrillation , sinus rhythm , catheter ablation , surgery , lesion , perioperative , pulmonary vein , cardiology
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.Conclusion 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. doi: 10.1111/jocs.12409 (J Card Surg 2014;29:757–762)