Objective: To evaluate the efficacy and safety of a modified technique for totally thoracoscopic left atrial posterior wall and pulmonary vein isolation in patients with long-standing persistent atrial fibrillation. Methods: From April 2017 to December 2018, we included in this study 28 consecutive patients who underwent thoracoscopic left atrial posterior wall and pulmonary vein radiofrequency isolation combined with left atrial appendage resection. We used a device with irrigated electrodes (Medtronic Cardioblate Gemini-s). The original surgical technique "GALAXY" proposed by Doty in 2012 was modified. The number of ablations was significantly increased, and frequent position changing of the ablation device and change of device angulation were added. Results: Sinus rhythm was restored in all patients. There was no operative mortality, no myocardial infarction, and no stroke or transient ischemic attack. One patient required sternotomy and another survived left anterolateral thoracotomy due to bleeding. A 180-day follow-up (24-hour Holter monitoring) revealed no sign of recurrence of atrial fibrillation or other supraventricular arrhythmia in any patient. Mean follow-up was nine months (range: 6-16 months). At the last follow-up, 26 patients (92,9%) were in sinus rhythm (24-hour Holter monitoring). Conclusion: A frequent ablation device position changing during the surgery makes it possible to achieve complete left atrial posterior wall and pulmonary veins isolation. An increased number of applications allows to avoid a false positive transmural damage assessment showed by impedance drop. Also, frequent position changing of the ablation device and increased number of applications do not affect the number of postoperative complications.

научно-клинический центр специализированных видов медицинской помощи и медицинских технологий» ФМБА России, 2 ФГБУ «Государственный научный центр Российской Федерации-Федеральный медицинский биофизический центр имени А.И.Бурназяна» ФМБА России Описываются методы неинвазивной протонно-лучевой аблации аритмогенного субстрата желудочковых тахикардий у больных со структурной патологией сердца направленные на устранение триггеров и/или разрушение re-entry механизмов при помощи пучка протонов.

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<p><strong>Aim.</strong> Endoscopic surgery demonstrates promising results of treatment in patients with non-paroxysmal atrial fibrillation. Minimally invasive thoracoscopic ablation contributes to the growing interest in such operations all over the world. Nowadays totally thoracoscopic ablations are available for patients in Russian Federation. Emphasis in our study was placed on the collection and analysis of data on thoracoscopic ablation procedures used for treating patients with lone atrial fibrillation.</p><p><strong>Methods.</strong> The study covered the operations performed by Russian cardiac surgeons over a period up until January 1, 2018. Data collection was based on emailed registration forms containing information about the date of procedures, type of ablation pattern, previous catheter procedures, used devices, methods of left atrial appendage closure and safety profile information. 30-day mortality, conversion to sternotomy/thoracotomy, stroke/ transient ischemic attack, reexplorations, cardiac tamponade and phrenic nerve damage were considered as major complications.</p><p><strong>Results</strong>. The study encompassed 10 cardiosurgical centers in Russian Federation where totally thoracoscopic ablations had been carried out between 2011– 2018. Six hundred fifty-two procedures were registered. Most patients were ablated in Dallas and Box Lesion patterns. Left atrial appendage exclusion was performed in 90,4% patients. Major complications were observed in 27 (4%) patients, mostly during the “learning curve” period.</p><p><strong>Conclusion.</strong> The given study is the first attempt to collect and systematize the data on a new surgical procedure for treatment of patients with atrial fibrillation. The data obtained allow for making a conclusion that thoracoscopic ablation is becoming a wide-spread surgical technique to treat patients with lone atrial fibrillation in Russia. The quantity of procedure increases annually. Introducing thoracoscopic procedures in clinical practice may be accompanied by complications at any center. Nevertheless, according to our investigation the rate of complications is low, which enables us to recommend thoracoscopic ablation to treat a numerous cohort of atrial fibrillation patients in Russia.</p><p>Received 13 June 2018. Revised 22 July 2018. Accepted 23 July 2018.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p>

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