Box lesion or bi-atrial lesion set for atrial fibrillation during thoracoscopic epicardial ablation

Abstract

OBJECTIVES Thoracoscopic epicardial ablation with a limited lesion set led to suboptimal results for advanced paroxysmal atrial fibrillation (AF) or persistent AF. Whether additional right atrial lesions improve the result is unclear. METHODS We conducted a retrospective study involving 80 consecutive patients with paroxysmal or persistent AF, left atrial (LA) dilation (LA diameter >40 mm) and failed prior interventional ablation (40 patients, 50%) who underwent thoracoscopic epicardial ablation with box lesions (36 patients) or bi-atrial (BA) lesion (44 patients) in our institution. Freedom from atrial tachyarrhythmias after the procedures was compared between the box lesion group and BA lesion group. RESULTS Baseline differences included more patients with persistent AF (86.4% vs 47.2%) and larger left atrium [48.00 (44.00–50.75) vs 42.00 (41.25–44.00) mm] in the BA lesion group. There was no difference in procedural complications between the 2 groups. After a mean follow-up of 32 months, the freedom from atrial tachyarrhythmias off antiarrhythmic drugs at 6, 12 and 24 months was 77.2%, 77.2% and 77.2% in the BA lesion group and 69.4%, 50.0% and 40.6% in the box lesion group, respectively (P = 0.006). After adjustment for sex, age, body mass index, LA diameter, AF type, history of AF, and previous interventional ablation, BA lesion was an independent predictor of lower atrial tachyarrhythmia recurrence (hazard ratio 0.447, 95% confidential interval 0.208–0.963; P = 0.040). CONCLUSIONS Compared with the box lesion set, thoracoscopic epicardial ablation with BA lesion sets might provide better freedom from atrial tachyarrhythmias for paroxysmal or persistent AF with LA dilation. Randomized control trials are warranted to confirm the benefit of BA lesion sets in these patients.

Thoracoscopic Surgical Biatrial Ablation vs. Catheter Ablation in Patients with Persistent Atrial Fibrillation

“…Our previous study demonstrated that adding right atrial lesion could improve the SR maintenance rate in thoracoscopic SA [11]. Previous studies did not show signifcant diference on the efcacy of CA versus SA in treating PerAF [6][7][8].…”

“…Te detailed procedure had been introduced in our previous studies [11,13], as described briefy in the following. Te access to the pericardial space was achieved through bilateral transthoracic approach.…”

“…Few studies have reported the results of thoracoscopic surgical biatrial ablation for patients with PerAF [11,12]. Furthermore, to our knowledge, there is no study comparing surgical biatrial ablation with CA for the treatment of PerAF so far.…”

Effectiveness of Maze IV procedure versus thoracoscopic ablation for atrial fibrillation: a propensity score-matched analysis

“…In the context of minimally invasive AF surgery, where anatomical constraints come into play, left atrial ablation combined with the Dallas lesion is undertaken. Nevertheless, we advocate for proactive exploration of appropriate methods for right atrial ablation in minimally invasive surgery ( 17 ). We caution against indiscriminate addition of ablation lines for right atrial ablation, as this has the potential to harm healthy atrial tissue.…”

Surface electrocardiogram f wave analysis in patients with atrial fibrillation undergoing thoracoscopic epicardial ablation

“…The details of the procedure were reported in our previous studies [ 6 , 7 ]. Briefly, the ablation was performed by bilateral access, with 3 ports in each side.…”