Key result
Thoracoscopic AF ablation achieves pulmonary vein block with a median of ~3 lines.
Why the study?
Total thoracoscopic ablation is recommended for atrial fibrillation, but the optimal number of ablation lines for pulmonary vein isolation has not yet been proposed.
Observational (n=20)
No
In patients undergoing total thoracoscopic ablation for atrial fibrillation, intraoperative conduction block is typically achieved within three ablation lines around the pulmonary vein antrum, suggesting that excessive ablation lines may be unnecessary.
May support limiting ablation lines in thoracoscopic AF ablation; leaves open prospective validation of outcomes.
Total thoracoscopic ablation has been recommended as a class IIa indication for atrial fibrillation. However, the optimal number of ablation lines for pulmonary vein isolation has not yet been proposed. This study aimed to report the minimum number of ablation lines required to achieve an intraoperative conduction block. This study included a total of 20 patients who underwent total thoracoscopic ablation from December 2020 to July 2021. The epicardial conduction block was checked after each ablation line of pulmonary vein antral clamping. The median age was 61 years old. The median duration of atrial fibrillation since the first diagnosis was 78 months. Pulmonary vein isolation with bidirectional conduction block was confirmed in 90% of patients. A median of six ablation lines around each pulmonary vein antrum were performed according to our protocol even after the conduction block was verified. The median number of ablations to achieve an exit block was two on the right side and 3.5 on the left side. We found that most conduction blocks were achieved within three ablations around the pulmonary vein antrum. Our results may provide evidence to reduce the number of unnecessary ablation lines in the future.
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Choi et al. (2023) conducted an observational in Atrial fibrillation (n=20). Total thoracoscopic ablation was evaluated on Minimum number of ablation lines required around the pulmonary vein antrum to achieve intraoperative conduction block. In patients undergoing total thoracoscopic ablation for atrial fibrillation, intraoperative pulmonary vein conduction block was achieved with a median of 2 ablation lines on the right and 3.5 on the left.
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