IMMEDIATE RESULTS OF THORACOSCOPIC ABLATION FOR TREATMENT OF PATIENTS WITH LONE ATRIAL FIBRILLATION

Background . Atrial fibrillation remains the most common sustained arrhythmia, with an expected increase in our aging population. In addition to the significant morbidity that is secondary to hemodynamic compromise and tachycardia-induced cardiomyopathy, stroke remains the most feared complication, with a 5-fold increased risk. New surgical approaches show promising results and perfect safety for treatment patients with different types of atrial fibrillation. Subject : to describe surgical technique and to evaluate the short-term efficacy and safety of radiofrequency thoracoscopic ablation (Dallas Lesion Set) in patients with lone atrial fibrillation. Material and Methods . Epicardial bipolar radiofrequency ablation was performed on the beating heart through a bilateral endoscopic approach in 127 consecutive patients with lone atrial fibrillation. This included isolation of the pulmonary veins using a clamp; isolation of the posterior left atrial wall, including a trigonal line to the aortic noncoronary sinus using a linear ablation device; and clip or resection of the left atrial appendage. Paroxismal atrial fibrillation was registered in 7% of patients; persistent and persistent long-standing atrial fibrillation was registered in 54 and 39% of patients respectively. Results . Mean duration of atrial fibrillation was 60 (24; 120) months. Mean operation time was 146.7±29.1 minutes. Complications rates were 24% during the learning curve period and 3.9% beyond this period. Freedom from atrial fibrillation and others rhythm disturbances was achieved in 90.5% of patients at discharge.  Conclusion . Endoscopic radiofrequency ablation on the beating heart demonstrated high success rates in patients with all types of atrial fibrillation. The rates of complications and procedure-related morbidity decreased at times beyond the learning curve period.