Long-term results of minimally invasive stand-alone bi-atrial surgical ablation with a bipolar ablation device for persistent and longstanding persistent AF: a single-center case series of 91 patients

Abstract

BackgroundMinimally invasive surgical treatment of lone atrial fibrillation (AF) is an alternative for AF that is refractory to medical treatment. We present long-term results of standalone surgical ablation of AF using a bipolar ablation device in 91 consecutive patients.MethodsThis was an observational, retrospective study of 91 patients (77 % males; mean age, 53 ± 10 years [range, 23–75 years]) who underwent minimally invasive standalone surgical ablation of persistent and longstanding persistent AF using a bipolar ablation device from 2008 to 2014. Mean follow-up was 60 ± 21 months. The absence of arrhythmia was confirmed at 3, 6, and 12 months, and annually thereafter, with 24-hour Holter monitoring.ResultsThe mean duration of preoperative AF was 6.5 ± 5.4 years. Persistent AF was present in 86 % of patients and longstanding persistent AF in 14 %. Mean left atrial diameter was 4.3 ± 0.8 cm. There were two postoperative strokes (2 %) and three conversions to median sternotomy (3 %). Permanent pacemakers were implanted in six (7 %) patients. There were no intra- or postoperative deaths. At 1, 2, 3, 4, and 5 years postoperatively, freedom from AF was 59, 45, 41, 38, and 38 % of patients, respectively. The failure to achieve pulmonary vein isolation was the only independent predictor of long-term recurrence of AF (HR −3 [95 % CI 1,858 to 8,586], p = 0,001). There was a tendency towards higher rates of SR at long term follow up in patients with pulmonary vein isolation if division of ligament of Marshall was performed (HR - 2 [95 % CI 0.987 to 4,202], p = 0,067).ConclusionsIn the present series, the efficacy of epicardial surgical ablation was similar to that reported previously. The rate of arrhythmia recurrence increased over time. Achieving pulmonary vein isolation is essential to AF elimination. The division of ligament of Marshall could contribute to improved rates of SR restoration in patients with persistent or long-standing persistent AF if PVI is achieved.

Long‐term outcome after totally thoracoscopic ablation for atrial fibrillation

“…Despite all new insights and development in clinical practice, long‐term rhythm control in patients with AF remains a major challenge, particularly for patients with (long‐standing) persistent and postablation AF. Past studies that have focused on long‐term rhythm outcome after (hybrid) thoracoscopic ablation have reported success rates varying between 38% and 83% up to 5 years, depending on follow‐up duration, AF subtype (paroxysmal vs nonparoxysmal) and antiarrhythmic drug usage, as shown in Table . As can be observed from this quick overview, the 60% success rate in our study is similar to what most of these studies have reported and confirms the steady reasonable results after thoracoscopic AF ablation.…”

“…Totally thoracoscopic epicardial ablation has evolved over the last decade towards a successful and safe minimally invasive rhythm control strategy, with a Class 2A indication, for patients with symptomatic drug refractory (long‐standing) persistent and postablation atrial fibrillation (AF) . The procedure is associated with a 79% freedom from AF after 2 years, but evidence for long‐term durability is still limited with reported success rates varying between 38% and 83% after a follow‐up up to 5 years . In addition, AF is associated with threefold to fivefold higher stroke rates, but information on the long‐term stroke risk after thoracoscopic ablation remains limited to a few studies reporting a low cerebrovascular event rate .…”

“…The procedure is associated with a 79% freedom from AF after 2 years, but evidence for long‐term durability is still limited with reported success rates varying between 38% and 83% after a follow‐up up to 5 years . In addition, AF is associated with threefold to fivefold higher stroke rates, but information on the long‐term stroke risk after thoracoscopic ablation remains limited to a few studies reporting a low cerebrovascular event rate . The aim of this study was to report on long‐term outcome after totally thoracoscopic ablation to provide cardiologists, surgeons and the multidisciplinary AF care team with adequate information for their decision in rhythm control therapy.…”

Thoracoscopic ablation of atrial fibrillation - Should we still be concerned about periprocedural complications?

“…Výběr pacientů v obou přehledech byl z hlediska našeho článku vyhovující -články s překrývajícími se soubory pacientů byly vyřazeny, články s příliš malými počty nemocných též. Do výběru byly přidány další tři velmi nedávné vhodné články, které v přehledech nebyly zahrnuty [36][37][38]. Ne všechny články bohužel obsahovaly sdělení, že komplikace byly defi novány podle plat-Material and methods: All perioperative and 30-day complications of thoracoscopic ablations of AF performed in our center were collected and analyzed.…”

Ten-year outcome of intraoperative treatment of atrial fibrillation using radiofrequency ablation

“…The data on long-term durability regarding the contribution of GP and LoM mapping and ablation compared to PV isolation have been minimal. 16 – 19 The ongoing Catheter Ablation vs Antiarrhythmic Drug Therapy for Atrial Fibrillation trial (CABANA) will report whether pulmonary vein isolation catheter ablation versus either rate or rhythm control by medical therapy is superior for the elimination of AF or whether catheter ablation decreases 5-year outcomes of mortality, disabling stroke, bleeding, or cardiac arrest in AF patients (Douglas Packer; Mayo Clinic; https://ClinicalTrials.gov/ct2/show/NCT00911508 ).…”