Video-assisted thoracoscopic surgical treatment of lone atrial fibrillation

A modified Maze procedure is a successful treatment for patients with chronic atrial fibrillation undergoing open cardiac surgery. We present our method and mid-term results of modified minimally invasive Maze procedure for patients with lone atrial fibrillation. Fifty-four patients (41 male patients; average age 58 years) with chronic lone atrial fibrillation underwent surgical treatment by video-assisted operation. All patients had unsuccessful drug therapy and 15 previous unsuccessful catheter ablations. The method includes bilateral pulmonary vein isolation, creation of a left atrial posterior wall line and exclusion of the left atrial appendage. We used one 10-mm camera port and a 5-cm working port on each chest side. Pulmonary vein isolation was achieved using a bipolar radiofrequency device. The left atrial appendage was excluded with a purse-string suture. Performance of the procedure was technically successful in all patients. There was no conversion to sternotomy or thora-cotomy. All patients were extubated in the operation room and all patients were in sinus rhythm at the end of the operation. In 15 patients intraoperative cardioversion was necessary. Echocardiography showed contractions of the left atrium and electrophysiological examination complete exit bloc across the ablation lines. Follow-up was complete at 3 months postoperatively for 48 patients (40 in sinus rhythm, 83%), at 6 months for 44 patients (37 in sinus rhythm, 84%) and at 1 year for 38 patients (32 in sinus rhythm, 84%). Bilateral video-assisted pulmonary vein isolation and creation of a left atrial posterior wall line is an effective treatment with stable functional mid-term results for patients with lone atrial fibrillation.