Evolution of Thoracoscopic Treatment of Atrial Fibrillation: From Inception to Contemporary Approaches

Highlights The development and implementation of video-assisted thoracoscopic atrial fibrillation ablation since 2005 by R. Wolf and colleagues have undergone a number of modifications for improvement and simplification. A study of the evolutionary development of thoracoscopic ablation of atrial fibrillation is necessary to optimize ablation recruitment and surgical technique for different forms of atrial fibrillation. Abstract There is a variety of treatments for atrial fibrillation (AF): therapeutic, interventional and surgical. The effectiveness of these methods varies significantly depending on the form of AF. For a long time, surgery was considered the only highly effective treatment for AF. In modern arrhythmology, «Maze IV» and its modifications are considered only as a simultaneous procedure in cardiac surgery. The work of M. Haïssaguerre et al. has established that the main focus of catheter ablation (CA) in AF should be the pulmonary veins, but their isolation in non-paroxysmal AF is questionable. This discovery has stimulated the development of alternative treatment modalities for resistant AF. Recently, video-assisted thoracoscopic epicardial ablation (TSA), which does not require sternotomy, cardiopulmonary bypass and cardioplegia, has been increasingly preferred. TSA of AF is an alternative surgical treatment for isolated forms of AF on the working heart. This procedure may include: pulmonary vein ablation, posterior left atrial wall and pulmonary vein ablation and left atrial appendage exclusion, but its effectiveness varies considerably due to the heterogeneity of patients, surgical technique and follow-up period. The aim of this review is to provide data on the evolutionary development of thoracoscopic ablation of AF depending on the choice of surgical access, ablation line set and ablation device.