Abstract
BackgroundThe aim of this study is to report the long-term efficacy and safety of thoracoscopic epicardial left atrial ablation (TELA) in patients with paroxysmal atrial fibrillation (AF).MethodsThis was a retrospective review of medical records. We included all patients diagnosed with paroxysmal AF who underwent TELA at our institution between 04/2011 and 06/2017. TELA included pulmonary vein isolation, LA dome lesions and LA appendage exclusion. All (n = 55) patients received an implantable loop recorder (ILR), 30 days post-operatively. Antiarrhythmic and anticoagulation therapy were discontinued at 90 and 180 days postoperatively, respectively, if patients were free of AF recurrence. Failure was defined as ≥two minutes of continuous AF, or atrial tachycardia.ResultsFifty-five patients (78% males, mean age = 61.6 years) qualified for the study. The average duration in AF was 3.64 +/− 3.4 years, mean CHA2DS2-VASc Score was 2.0 +/− 1.6. The procedure was attempted in 57 patients and completed successfully in 55 (96.5%). Two patients experienced a minor pulmonary vein bleed that was managed conservatively. Post procedure, one patient experienced pulmonary edema, another experienced a pneumothorax requiring a chest tube and another experienced acute respiratory distress syndrome resulting in longer hospitalization. Otherwise, there were no major procedural complications. Success rates were 89.1% (n = 49/55), 85.5% (n = 47/55) and 76.9% (n = 40/52) at 6, 12 and 24 months, respectively. In the multivariate cox-proportional hazard model, survival at the mean of covariates was 86 and 74% at 12 and 24 months, respectively.ConclusionIn this single center experience, TELA was a safe and efficacious procedure for patients with paroxysmal AF.
Highlights
Atrial fibrillation (AF) is the most common cardiac arrhythmia with several adverse consequences related to a reduction in cardiac output, and to ischemic cerebrovascular accidents or peripheral embolization due to atrial and atrial appendage thrombus formation [1]
In 2006, Wolf et al [5] described a video-assisted thoracoscopic surgical ablation consisting of pulmonary vein isolation (PVI) from the epicardial side with a bipolar radiofrequency clamp, ablation of ganglia over the left atrial (LA) surface, and excision of the LA appendage
HRS/ EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation recommends stand-alone surgical ablation as a reasonable option for persistent and long-standing patients who have failed one or more attempts at catheter ablation who prefer a surgical approach after review of safety and efficacy of options
Summary
Atrial fibrillation (AF) is the most common cardiac arrhythmia with several adverse consequences related to a reduction in cardiac output, and to ischemic cerebrovascular accidents or peripheral embolization due to atrial and atrial appendage thrombus formation [1]. The Society of Thoracic Surgeons 2017 Clinical Practice Guidelines for the Surgical Treatment of Atrial Fibrillation recommends stand-alone surgical ablation for symptomatic AF without structural heart disease in patients who have failed a class I or III antiarrhythmic medication or catheter-based therapy [11]. The aim of this retrospective study was to assess the long-term efficacy and safety of TELA as a stand-alone procedure in patients with paroxysmal atrial fibrillation. The aim of this study is to report the long-term efficacy and safety of thoracoscopic epicardial left atrial ablation (TELA) in patients with paroxysmal atrial fibrillation (AF)
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