Zbyněk Straka1, Petr Budera2, Pavel Osmančík3, Marek Malý4, Tomáš Vaněk1. 1. Cardiocenter, Third Faculty of Medicine, Charles University in Prague, Prague, Czech Republic Department of Cardiac Surgery, University Hospital Kralovské Vinohrady, Prague, Czech Republic. 2. Cardiocenter, Third Faculty of Medicine, Charles University in Prague, Prague, Czech Republic Department of Cardiac Surgery, University Hospital Kralovské Vinohrady, Prague, Czech Republic budera@atlas.cz. 3. Cardiocenter, Third Faculty of Medicine, Charles University in Prague, Prague, Czech Republic Department of Cardiology, University Hospital Kralovské Vinohrady, Prague, Czech Republic. 4. National Institute of Public Health, Prague, Czech Republic.
Abstract
OBJECTIVES: Minimally invasive surgery for atrial fibrillation (AF) has rapidly evolved recently. The long-term efficacy of most of these procedures is poorly known. METHODS: Between 2006 and 2010, 38 drug-resistant, symptomatic patients with stand-alone AF underwent unilateral, thoracoscopic, off-pump ablation. The mean age was 60 ± 8.2 (range 42-75) years and the mean AF duration was 46 ± 62 (range 3-240) months. Sixteen patients (42%) had paroxysmal, 9 (24%) had persistent and 13 (34%) had long-standing persistent AF. A box lesion was created using a microwave (26 patients) or monopolar radiofrequency (12 patients) system. Patients were prospectively followed with repeat electrocardiograms (ECGs) and ECG Holters. Additional catheter ablation was offered to patients with recurrence of arrhythmia. RESULTS: All procedures were completed as planned with one conversion to sternotomy, zero mortality and minimal in-hospital complications. The mean follow-up duration was 70 ± 19 (range 20-88) months. Arrhythmia-free survival rates after the procedure were 50, 44.4, 24.1 and 10.8% at 6, 12, 36 and 60 months, respectively, with most recurrences in the first 6 months. Twelve patients underwent additional catheter ablation(s); from the last intervention, 75% of them were in sinus rhythm (SR) with a mean follow-up of 31 ± 23 (range 4-86) months. Overall, at the end of follow-up, only 3 patients were still in SR without any arrhythmia recurrence. Major complications (cerebral, peripheral embolism or bleeding) occurred in 5 patients. CONCLUSIONS: Unilateral, thoracoscopic AF ablation is safe and technically feasible. However, the results of the microwave and monopolar radiofrequency devices were less than satisfactory, with a gradual decline in arrhythmia-free survival over a very long-term follow-up.
OBJECTIVES: Minimally invasive surgery for atrial fibrillation (AF) has rapidly evolved recently. The long-term efficacy of most of these procedures is poorly known. METHODS: Between 2006 and 2010, 38 drug-resistant, symptomatic patients with stand-alone AF underwent unilateral, thoracoscopic, off-pump ablation. The mean age was 60 ± 8.2 (range 42-75) years and the mean AF duration was 46 ± 62 (range 3-240) months. Sixteen patients (42%) had paroxysmal, 9 (24%) had persistent and 13 (34%) had long-standing persistent AF. A box lesion was created using a microwave (26 patients) or monopolar radiofrequency (12 patients) system. Patients were prospectively followed with repeat electrocardiograms (ECGs) and ECG Holters. Additional catheter ablation was offered to patients with recurrence of arrhythmia. RESULTS: All procedures were completed as planned with one conversion to sternotomy, zero mortality and minimal in-hospital complications. The mean follow-up duration was 70 ± 19 (range 20-88) months. Arrhythmia-free survival rates after the procedure were 50, 44.4, 24.1 and 10.8% at 6, 12, 36 and 60 months, respectively, with most recurrences in the first 6 months. Twelve patients underwent additional catheter ablation(s); from the last intervention, 75% of them were in sinus rhythm (SR) with a mean follow-up of 31 ± 23 (range 4-86) months. Overall, at the end of follow-up, only 3 patients were still in SR without any arrhythmia recurrence. Major complications (cerebral, peripheral embolism or bleeding) occurred in 5 patients. CONCLUSIONS: Unilateral, thoracoscopic AF ablation is safe and technically feasible. However, the results of the microwave and monopolar radiofrequency devices were less than satisfactory, with a gradual decline in arrhythmia-free survival over a very long-term follow-up.
Authors: Rukshen Weerasooriya; Paul Khairy; Jean Litalien; Laurent Macle; Meleze Hocini; Frederic Sacher; Nicolas Lellouche; Sebastien Knecht; Matthew Wright; Isabelle Nault; Shinsuke Miyazaki; Christophe Scavee; Jacques Clementy; Michel Haissaguerre; Pierre Jais Journal: J Am Coll Cardiol Date: 2011-01-11 Impact factor: 24.094
Authors: Mark La Meir; Sandro Gelsomino; Fabiana Lucà; Laurent Pison; Andrea Colella; Roberto Lorusso; Elena Crudeli; Gian Franco Gensini; Harry G Crijns; Jos Maessen Journal: Europace Date: 2012-07-10 Impact factor: 5.214