Surgical Minimally Invasive Pulmonary Vein Isolation for Lone Atrial Fibrillation

Abstract

<jats:sec><jats:title>Objective</jats:title><jats:p> Minimally invasive surgical pulmonary vein isolation (SMI-PVI) is an emerging therapy for the treatment of symptomatic drug-refractory atrial fibrillation (AF). Nevertheless, the midterm and long-term results of SMI-PVI remain unknown. The aim of this retrospective multicenter study was to report on midterm efficacy and safety of SMI-PVI. </jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p> The study design was retrospective, multicentric, and observational. From July 2005 to November 2011, a total of 86 patients with drug-refractory paroxysmal or persistent AF underwent SMI-PVI in three centers. Patients were eligible for SMI-PVI if they had symptomatic, drug-refractory AF or after failed transcatheter pulmonary vein isolation. Success was defined as absence of AF on 24- or 96-hour Holter monitoring during follow-up, in the absence of antiarrhythmic drugs (AADs). </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> The mean ± SD age was 54 ± 11 years, and 78% were men. The median AF duration was 30 months (range, 2–203); paroxysmal AF was present in 86% of the patients, persistent in 14%. Fifteen patients (17%) underwent previous transcatheter ablations. After a median follow-up of 24 months (range, 6–78), 72% of all patients were free from atrial arrhythmias without the use of AADs. With AADs, this was 83%. Major perioperative adverse events occurred in 7 patients (8%). </jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p> This retrospective multicenter study shows that SMI-PVI is effective at a median follow-up of 24 months for the treatment of mostly paroxysmal drug-refractory AF. Perioperative adverse events do remain a point of caution. </jats:p></jats:sec>

Surgical Left Atrial Appendage Exclusion Does Not Impair Left Atrial Contraction Function: A Pilot Study

“…In the present series, no periprocedural bleeding was observed and, specifically, no LAAA related bleedings. This notwithstanding, LAAA related bleedings have been reported, due to the fragile and delicate wall of the LAAA [ 21 , 22 ].…”

Minimally invasive surgery for atrial fibrillation

“…De Maat reported multicenter results of minimally invasive PVI in a cohort of 86 patients with 86% paroxysmal AF, median AF duration of 30 months, and mean LA diameter of 4.2 cm. In this near-ideal group of patients for stand-alone PVI, freedom from ATAs off AADs was 69% at three-year follow-up (34). A followup report that retrospectively matched a subset of these patients undergoing surgical PVI to a group of patients undergoing catheter PVI showed superior freedom from ATAs in the surgical PVI group at 12 months follow-up (88 vs. 41%, p<0.001) (35).…”

Impact of Thoracoscopic Pulmonary Vein Isolation on Right Ventricular Function: A Pilot Study

“…We studied a series of patients who underwent sPVI as a first PVI procedure during the period of 2009–2011 in our university medical center. Inclusion criteria were highly symptomatic paroxysmal or early persistent AF, without concomitant cardiac structural disease, refractory to class I and/or class III antiarrhythmic drugs [ 2 ]. Exclusion criteria for surgical PVI were left atrial size > 55 mm (parasternal view), prior transcatheter PVI, prior heart or lung surgery, significant coronary disease or previous myocardial infarction, left ventricle hypertrophy > 12 mm, previous hospitalization for heart failure, left ventricular dysfunction (ejection fraction < 50%), moderate or severe mitral or aortic valve disease, or lung disease (prior tuberculosis or chronic obstructive pulmonary disease, GOLD classes III-IV).…”

“…In the recent years, thoracoscopic surgical pulmonary vein isolation (sPVI) has been added to the treatment of atrial fibrillation (AF). This technique has been shown to be safe and numerous studies have shown excellent efficacy outcome in paroxysmal and short-standing persistent AF due to high transmurality yielded epicardially by bipolar radiofrequency devices [ 1 , 2 ]. However, right ventricular (RV) function following sPVI has not been investigated.…”