Abstract | BACKGROUND: To analyze safety and efficacy of surgical totally endoscopic epimyocardial ablation in patients (pts) turned down for interventional catheter therapy due to long-standing persistent atrial fibrillation (pAF) combined with significant atrial dilatation (> 5 cm). METHODS: Since December 2010, 15 pts were referred for surgical ablation due to persistent AF combined with biatrial dilatation (left atrium [LA] 5.0 ± 0.6 cm). Mean age was 52 ± 6 years, body mass index (BMI) 38 ± 6, duration of AF 2.8 ± 1.2 years, left ventricular end diastolic diameter (LVEDD) 5.8 cm ± 0.6 cm. Ablation was performed via a bilateral endoscopic approach using bipolar RF energy application. Monitoring was achieved by an event recorder (Reveal XT Medtronic, Inc., Minneapolis, MN, USA) or repeated 24-hours Holter electrocardiogram. RESULTS: All pts successfully received bilateral pulmonary vein isolation + box lesion + trigonal lesion + left atrial appendage resection. Mean duration of procedure was 235 ± 70 minutes. There was no intraoperative complication; however, one patient had persistent left phrenic nerve palsy. Mean hospital stay was 4 ± 2 days, mean follow-up time was 21 ± 11 months. Incidence of sinus rhythm (SR) was 67, 73, and 80% at discharge, three months, and 12 months follow-up. Mean LA diameter was reduced from 58.1 mm ± 6.0 mm preoperative to 49.7 mm ± 5.4 mm (p = 0.004) at 12 months follow-up. Incidence of SR was 86% at latest follow-up (mean time 21 months). All pts currently in SR (13/15 = 86%) are of class I or III antiarrhythmic drugs. CONCLUSION: Totally endoscopic left atrial ablation including left atrial resection can safely be performed. It achieved excellent rates of SR restoration in patients with long-standing persistent AF combined with significant atrial dilatation.
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Authors | Florian Mathias Wagner, Simon Pecha, Lenard Conradi, Hermann Reichenspurner |
Journal | Journal of cardiac surgery
(J Card Surg)
Vol. 30
Issue 5
Pg. 469-73
(May 2015)
ISSN: 1540-8191 [Electronic] United States |
PMID | 25754505
(Publication Type: Evaluation Study, Journal Article)
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Copyright | © 2015 Wiley Periodicals, Inc. |
Topics |
- Aged
- Atrial Fibrillation
(pathology, surgery)
- Catheter Ablation
(methods)
- Dilatation, Pathologic
- Feasibility Studies
- Female
- Follow-Up Studies
- Heart Atria
(pathology, surgery)
- Humans
- Male
- Middle Aged
- Myocardium
- Retrospective Studies
- Thoracoscopy
(methods)
- Treatment Outcome
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