Treatment of lone atrial fibrillation: minimally invasive pulmonary vein isolation, partial cardiac denervation and excision of the left atrial appendage.

Since 1999, my colleagues and I have diligently pursued a minimally invasive surgical, beating-heart, left atrial isolation technique that is offered to patients with lone atrial fibrillation (AF). We began clinical cases in 2003. In 2005, we reported our initial experience with video-assisted bilateral pulmonary vein (PV) isolation and left atrial appendage (LAA) exclusion for the minimally invasive treatment of AF (Wolf technique). From our experience in over 1,000 cases there have been many lessons learned in the evaluation, selection and minimally invasive surgical treatment of patients with lone AF. In our experience we have had zero mortality and no conversions to sternotomy. Recently we reviewed 157 patients who are now 1 to 9 years out from the Wolf technique. The patients' ages ranged from 15 to 87 years old. The AF-free rate for paroxysmal AF was 92%, for persistent AF 85%, and for long-standing persistent AF 75%. The follow-up included 7-day continuous monitoring. There were no deaths (personal review). The Wolf technique is a safe and effective treatment for selected patients with lone AF.