Thoracoscopic Video-Assisted Pulmonary Vein Antrum Isolation, Ganglionated Plexus Ablation and Periprocedural Confirmation of Ablation Lesions. First Results of a Hybrid Surgical-Electrophysiological Approach for Atrial Fibrillation

BACKGROUND: -Thoracoscopic pulmonary vein isolation (PVI) and ganglionated plexus (GP) ablation is a novel approach in the treatment of atrial fibrillation (AF). We hypothesize that meticulous electrophysiological confirmation of PVI results in fewer recurrences of AF during follow-up. METHODS AND RESULTS: -Surgery was performed through three ports bilaterally. GPs were localized and subsequently ablated. PVI was performed and entry and exit block was confirmed. Additional left atrial ablation lines (ALAL) were created, and conduction block verified, in patients with non-paroxysmal AF. The left atrial appendage was removed. Freedom of AF was assessed by ECGs and Holter monitoring every 3 months or during symptoms of arrhythmia. Anti-arrhythmic drugs (AAD) were discontinued after 3 months and oral anticoagulants were discontinued according to the guidelines. Thirty-one patients were treated (16 paroxysmal AF, 13 persistent AF, 2 long standing persistent (LSP) AF). Thirteen patients with non-paroxysmal received ALAL. After one year, 19/22 patients (86%) had no recurrences of AF, atrial flutter or atrial tachycardia and were not using AAD (11/12 paroxysmal, 7/9 persistent, 1/1 LSP). Three patients had a sternotomy because of uncontrolled bleeding during thoracoscopic surgery. Four adverse events were; 1 hemothorax, 1 pneumothorax and 2 pneumonia. No thromboembolic complications or mortality occurred. CONCLUSIONS: -Thoracoscopic surgery with PVI and GP ablation for AF is a safe and successful procedure with a single procedure success rate of 86% at one year. Electrophysiological guided thorough PVI and ALAL creation presumably contributes in achieving a high success rate in the surgical treatment of AF