Abstract
Minimally invasive surgical ablation is generally contraindicated in patients with atrial fibrillation and thrombosis of the left atrial appendage.We have treated three of these patients using an innovative technique based on a bilateral video-thoracoscopic approach, performing a continuous encircling lesion at the pulmonary veins outflow with radio-frequency ablation, simultaneously excluding the left atrial appendage. The postoperative course was uneventful, without neurologic events and all patients maintained a stable sinus rhythm at 1-year follow-up.This procedure represents a new mini-invasive method to treat persistent atrial fibrillation when partial thrombosis of the left atrial appendage contraindicates other ablation techniques.
Highlights
In patients with persistent atrial fibrillation (AF) and left atrial appendage (LAA) thrombosis, current ablation techniques are contraindicated[1]
We report a new mini-invasive surgical approach that has been shown to be effective in the treatment of both AF and LAA thrombosis by restoring sinus rhythm and avoiding potentially severe neurological complications
Transoesophageal echocardiography (TEE) monitoring is of paramount importance to confirm or detect any LAA thrombus (Figure 1) and is maintained throughout the procedure
Summary
In patients with persistent atrial fibrillation (AF) and left atrial appendage (LAA) thrombosis, current ablation techniques are contraindicated[1]. During single left lung ventilation, the right hemithorax is approached (Figure 2B), the pericardium opened and exposed. Blunt dissection with Endopeanuts (US Surgical, Norwalk, CT) is performed between the superior vena cava and the right superior pulmonary vein, reaching the transverse sinus. The oblique sinus is exposed by dissecting the inferior vena cava from the right inferior pulmonary vein. Multiple lesions are performed (60 seconds at 70°C each) moving the catheter circumferentially to treat all underlying structures At this stage, external electrical cardioversion is performed whenever the sinus. Through the left hemithorax, the base of LAA is measured with the dedicated sizer and an Atricure AtriClip Pro II is introduced through the most caudal port. The accesses are closed, after partial pericardium suturing and chest tubes placement
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