January 6, 2012Interactive Cardiovascular and Thoracic SurgeryOpen Access

Minimally invasive thoracoscopic hybrid treatment of lone atrial fibrillation: early results of monopolar versus bipolar radiofrequency source

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Why the study?

Does hybrid bipolar thoracoscopic radiofrequency ablation reduce postoperative atrial fibrillation compared to monopolar ablation in patients with lone atrial fibrillation?

Structured PICO

Does hybrid bipolar thoracoscopic radiofrequency ablation reduce postoperative atrial fibrillation compared to monopolar ablation in patients with lone atrial fibrillation?

Population

54 patients with lone atrial fibrillation (LAF), including long standing persistent, persistent, and paroxysmal AF.

Intervention

Hybrid bipolar/bilateral thoracoscopic radiofrequency ablation

Comparator

Hybrid monopolar/monolateral thoracoscopic radiofrequency ablation

Outcome

One-year time-related prevalence of postoperative atrial fibrillationhard clinical

Hybrid bipolar thoracoscopic ablation demonstrates superior 1-year success rates for maintaining sinus rhythm and promoting left atrial reverse remodeling compared to monopolar ablation in patients with lone atrial fibrillation.

Implication

Bipolar ablation was associated with lower postoperative AF; leaves open superiority over monopolar pending randomized confirmation in lone AF.

Abstract

We compare results of a hybrid monopolar vs. a hybrid bipolar thoracoscopic approach employing radiofrequency (RF) sources for the surgical treatment of lone atrial fibrillation (LAF). From January 2008 to June 2010, 19 patients (35.1%) underwent RF monopolar/monolateral RF ablation, whereas 35 (64.9%) had RF bipolar/bilateral thoracoscopic ablation. One-year time-related prevalence of postoperative AF was 13.3 (11.0-17.4) and 5.2% (4.2-6.7), in monopolar and bipolar groups, respectively (P < 0.001). It was 21.1 (17.6-24.9) vs. 8.2% (5.1-11.6) in long standing persistent (P < 0.001), 13.2 (10.6-17.8) vs. 3.8% (1.4-6.9) in persistent (P < 0.001) and 5.6 (2.8-8.3) vs. 3.2% (1.0-6.5) in paroxysmal AF (P = 0.64). At 12 months, estimated prevalence of anti-arrhythmic drugs was 26 (22.4-30.1) and 18.0% (15.5-21.7, P = 0.04), whereas prevalence of warfarin use was 48.2 (44.2-52.2) and 29.0% (26.2-33.1, P < 0.001) in the monopolar and bipolar groups, respectively. Left atrial (LA) reverse remodelling occurred in 47.3% of monopolar patients (n = 9) and in 77.1% of bipolar patients (P = 0.03). The hybrid bilateral approach with a bipolar device for the treatment of LAF showed a good 1-year success rate independently of the AF type and seems to be the better choice for longstanding persistent and persistent LAF.