The effectiveness of thoracoscopic treatment of non-paroxysmal atrial fibrillation

Aim. To evaluate the efficacy of thoracoscopic ablation (TSA) of persistent and long-standing atrial fibrillation (AF) in the long-term follow-up period. Methods. TSA of AF with unilateral left atrial appendage exclusion was performed in 50 patients with persistent (group I) and 50 patients with long-onset AF (group II). Efficacy was defined as the absence of any atrial tachyarrhythmia (atrial fibrillation, atrial flutter, or supraventricular tachycardia) lasting more than 30 seconds recorded on Holter ECG monitoring at study controls. Results. TSA was 78% effective in group I and 63% effective in group II over the three-year follow-up period (p=0,037). Catheter ablations 3 months after TSA were required in 8 (16%) patients in group I and 9 (18%) in group II (p>0,05), of which two patients had typical atrial flutter on ECG, which required radiofrequency ablation of the cavotricuspid isthmus. The efficacy of staged treatment of AF at 3 months after additional catheter ablation was 100% and 88,2% after 6 months. Conclusion. Video-assisted thoracoscopic ablation of atrial fibrillation should be considered a promising approach for the management of persistent and long-standing atrial fibrillation.