Thoracoscopic Ablation of Persistent Atrial Fibrillation on the Beating Heart

• Published in: The Thoracic and Cardiovascular Surgeon
• Main Authors: Mühle, A., Chou, D., Te Winkel, M., Khoynezhad, A.
• Format: Conference Proceeding
• Language: English
• Published: 20.01.2015
• ISSN: 0171-6425; 1439-1902
• DOI: 10.1055/s-0035-1544498

Background: Atrial fibrillation (AF) is the most common sustained arrhythmia and is associated with a nearly 5-fold increased risk for stroke as well as over 2-fold increased risk of death. For symptomatic drug-refractory AF, percutaneous ablation has been used with good success in paroxysmal AF. For patients with persistent AF, the results of catheter ablation are poor. Therefore, surgical AF using minimal-invasive approaches is offered to this cohort. We analyzed our data in thoracoscopically-performed ablation of AF. Methods: From January 2012 through March 2014, a total of 27 symptomatic and drug-refractory patients with lone AF underwent a thoracoscopic epicardial ablation on the beating heart using the bipolar radiofrequency energy source. All of them had persistent long-standing AF and besides one patients also a history of at least one percutaneous catheter ablation. Epicardial ablation was performed on 19 men (70%) and 8 women (30%), with a mean age of 64 (range 47 to 82) years. After the ablation, in all patients entrance and exit block was confirmed, the ganglionic plexi were ablated, and the left atrial appendage was excluded. Results: The mean operative time was 4.6 hour and the mean postoperative length of stay was 6.5 days. In one patient cardiopulmonary bypass was used due to a laceration of the left atrial appendage. There were no hospital deaths, strokes or myocardial infarctions. The heart rhythm was documented in all of them besides 7 patients with a holder-ECG with duration of at least of 7-days. In 2 patients the postoperatively persistent AF was treated with radiofrequency ablation. Pacemaker implantation was done in 3 patients (11%) due to bradycardia ( n  = 2) and sick-sinus syndrome ( n  = 1). There were 2 late deaths (7%) one due to pulmonary embolism (PE) with a previous history of PE and the other patient died due to a major stroke. The follow-up was completed in 81.5% with a mean length of 11 months (range 90 to 793 days) with a freedom of AF in 85%. Conclusion: Thoracoscopic AF ablation on the beating heart for treatment of AF is technical feasible and achieve high success rates with low procedure-related morbidity in early follow-up.