Minimally Invasive Surgical Treatment of Atrial Fibrillation: A New Look at an Old Problem

Over the past twenty years, we have utilized a minimally invasive, nonsternotomy, no-pump, beating heart surgical procedure to successfully treat over 3,000 atrial fibrillation (AF) patients 1 1We have recently obtained IRB approval to retrospectively review the last three years of patient data, with implantable loop recorder results. with outcomes that surpass those of tradition pulmonary vein isolation (PVI). 1 , 2 The procedure consists of bilateral minithoracotomies, left atrial isolation, electrical isolation of the superior vena cava, partial cardiac denervation, intraoperative EP testing and closure of the left atrial appendage. Patients are extubated at the end of the procedure in the operating room, and after a brief stay in PACU, are admitted to the regular floor (no ICU stay). This procedure has proven efficacious in all types of AF. Patient selection, details of the procedure, and postoperative care are described here. An alternative mechanism of action, and precise partial cardiac denervation, although not new, is presented.