Key result
Epicardial pulmonary vein isolation using VATS with high-intensity focused ultrasound for lone atrial fibrillation achieved a success rate of 40% at 6 months and caused substantial complications.
Why the study?
Does epicardial pulmonary vein isolation using minimal invasive surgery and high-intensity focused ultrasound improve rhythm control in patients with lone atrial fibrillation refractory to antiarrhythmic drugs?
Observational (n=15)
Does epicardial pulmonary vein isolation using minimal invasive surgery and high-intensity focused ultrasound improve rhythm control in patients with lone atrial fibrillation refractory to antiarrhythmic drugs?
Epicardial PVI using VATS with HIFU for lone AF is associated with a low success rate and substantial complications, indicating a need for alternative techniques.
Does not support clinical adoption; leaves open whether refined epicardial HIFU approaches merit further trials.
AIMS: Transvenous pulmonary vein isolation (PVI) is the cornerstone of non-pharmacological rhythm control therapy in symptomatic atrial fibrillation (AF). Success and complications rates are, however, still not optimal. New techniques and energy sources are therefore being developed. METHODS AND RESULTS: Fifteen patients with lone AF refractory for antiarrhythmic drugs (AADs) underwent PVI by minimal invasive epicardial off-pump monolateral right-sided video-assisted thoracic surgery (VATS) using the UltraCinch with high-intensity focused ultrasound (HIFU). Primary endpoint was successful ablation defined as absence of AF or atrial flutter/tachycardia after 6 months assessed by complaints, 12 lead electrocardiogram, and 96 h Holter monitoring. Secondary endpoints were ablation success at the end of follow-up irrespective of AADs use or re-ablation and complications related to the procedure. Mean age was 47 +/- 10 years and 14 (93%) were male. Eleven (73%) had paroxysmal, and 4 (27%) patients had persistent AF. Median AF history was 5 (1-12) years. At 6 months, six (40%) patients had sinus rhythm after one epicardial PVI (four on AADs). After 1.3 +/- 0.6 years, four (27%) patients had sinus rhythm after one epicardial PVI (two on AADs) and in six (40%) patients endocardial radiofrequency re-ablation was performed, which was successful in three patients (20%). Two patients (13%) were planned for re-ablation. Three others (20%) refused re-ablation. Two major complications occurred (one late tamponade and one bleeding during surgery, necessitating sternotomy). CONCLUSION: Epicardial PVI using monolateral right-sided VATS with the UltraCinch delivering HIFU is feasible, but is associated with substantial complications. Furthermore, the success rate was low. More research is therefore warranted to assess optimal ablation techniques and energy sources to perform PVI.
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Klinkenberg et al. (2009) conducted an observational in Lone atrial fibrillation (n=15). Epicardial pulmonary vein isolation by minimal invasive VATS using UltraCinch with high-intensity focused ultrasound (HIFU) was evaluated on Successful ablation defined as absence of AF or atrial flutter/tachycardia after 6 months. Epicardial pulmonary vein isolation using VATS with high-intensity focused ultrasound for lone atrial fibrillation achieved a success rate of 40% at 6 months and caused substantial complications.
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