Objectives: Percutaneous pulmonary vein isolation (PVI) is the treatment of choice for symptomatic, drug-refractory atrial fibrillation (AF). A minimally invasive surgical approach can, however, provide an attractive alternative. The objective of this study was to assess the feasibility, effectiveness and safety of a complete thoracoscopic procedure to cure AF.
Methods: A bilateral ‘video assisted thoracoscopy’ was used to isolate both sets of pulmonary veins with bipolar RF-energy, ablate ganglionic plexus (GP) and amputate the left atrial appendage. Preoperative, in-hospital and follow-up data were studied of our first 30 patients. Holter registration was available in 91% of the patients who had no registered relapse of AF.
Results: Forty-three percent of the patients had undergone a previous percutaneous PVI. AF was paroxysmal in 63%, persistent in 27% and permanent in 10%. Mean left atrial diameter was 42.1±7.4 mm and mean duration of AF was 79.0±63.9 months. During a mean follow-up of 11.6 months, freedom from AF was obtained in 77% of the patients. There was no significant difference in freedom from AF between patients with paroxysmal, persistent or permanent AF. All patients who had a history of percutaneous PVI were free from AF during follow-up. Complications consisted of a conversion to a sternotomy in 2 patients, because of bleeding and severe pleural adhesions. During follow-up no CVA’s or pacemaker implantation occurred and none of the patients died
Conclusions: A complete thoracoscopic PVI with GP ablation and amputation of the left atrial appendage is feasible, effective and safe for the treatment of lone AF.
Image
