Key result
Giant LA linked to ~15% lower absolute freedom from arrhythmia after surgical AF ablation.
Why the study?
PVI efficacy for AF decreases with increasing LA volume, but the efficacy of surgical AF ablation in patients with a giant LA remains unknown.
What is the efficacy of thoracoscopic AF ablation in patients with a giant left atrium compared to those without?
Cohort (n=442)
No
What is the efficacy of thoracoscopic AF ablation in patients with a giant left atrium compared to those without?
Thoracoscopic AF ablation provides freedom from atrial tachyarrhythmias in 42.6% of patients with a giant left atrium at 2 years, suggesting it may be a viable last-resort option despite lower efficacy than in non-GLA patients.
Thoracoscopic ablation shows lower success in giant left atrium; extends left atrial size observations but leaves optimal strategy open.
PURPOSE: Efficacy of pulmonary vein isolation (PVI) for atrial fibrillation (AF) decreases as left atrial (LA) volume increases. However, surgical AF ablation with unknown efficacy is being performed in patients with a giant LA (GLA). We determined efficacy of thoracoscopic AF ablation in patients with compared to without a GLA. METHODS: . Follow-up was performed with ECGs and 24-h Holters every 3 months. After a 3-month blanking period, all antiarrhythmic drugs were discontinued. The primary outcome was freedom of any atrial tachyarrhythmia ≥ 30 s during 2 years of follow-up. GLA patients were older (61.9 ± 6.9 vs 59.4 ± 8.8 years, p = 0.02), more often diagnosed with persistent AF (76.5% vs 58.6%, p = 0.008). Sex was equally distributed (with approximately 25% females). GLA patients had more recurrences compared to non-GLA patients at 2-year follow-up (42.6% vs 57.2%, log rank p = 0.02). Freedom of AF was 69.0% in non-GLA paroxysmal AF patients compared to 43.8-49.3% in a combined group of GLA and/or persistent AF patients(log rank p < 0.001). Furthermore, freedom was 62.4% in non-GLA male patients, compared to 43.8-47.4 in a combined group of GLA and/or female sex(log rank p = 0.02). CONCLUSION: Thoracoscopic AF ablation is an effective therapy in a substantial part of GLA patients. Thoracoscopic AF ablation may serve as a last resort treatment option in these patients.
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Neefs et al. (2021) conducted a cohort in Atrial fibrillation (n=442). Thoracoscopic surgical AF ablation vs. Patients without a giant left atrium was evaluated on Freedom of any atrial tachyarrhythmia ≥ 30 s (p=0.02). Thoracoscopic surgical AF ablation resulted in freedom from atrial tachyarrhythmia in 42.6% of patients with a giant left atrium compared to 57.2% in patients without a giant left atrium at 2 years.
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