Minimally invasive surgical pulmonary vein isolation with ganglionic plexi ablation achieved an overall single-procedure success rate of 46.6% at 60 months, with higher success in paroxysmal (51.8%) compared to persistent (28.2%) atrial fibrillation.
Cohort (n=139)
No
Does minimally invasive surgical pulmonary vein isolation, ganglionic plexi ablation, and left atrial appendage exclusion prevent recurrence of atrial arrhythmias in patients with symptomatic, drug-refractory lone atrial fibrillation?
Minimally invasive surgical PVI with GP ablation and LAA exclusion provides moderate long-term freedom from atrial arrhythmias, with better outcomes observed in patients with shorter AF duration, smaller left atrial size, and no early recurrence.
BACKGROUND: Ganglionated plexi (GP) ablation has been become an adjunct to pulmonary vein isolation (PVI). This study describes the long-term results of minimally invasive surgical PVI, ablation of GPs, and exclusion of the left atrial appendage for atrial fibrillation (AF). METHODS: Long-term follow-up of 55 months was performed in 139 consecutive patients (age 58.3±20.8 years) with symptomatic, drug-refractory lone AF who underwent minimally invasive surgical PVI, GPs ablation, and exclusion of the left atrial appendage. Success was defined as freedom from AF, atrial flutter, or atrial tachycardia off antiarrhythmic drugs. RESULTS: AF was paroxysmal in 77.7%, persistent in 12.2% and long-standing persistent in 10.1%. Single-procedure success rate was 71.7%, 59.4% and 46.6% at 12, 24 and 60 months respectively. Single-procedure success rate was 72.9%, 62.6% and 51.8% for paroxysmal AF, 64.7%, 35.3%, and 28.2% for persistent AF, 71.4%, 64.3% and 28.6% for long-standing persistent AF at 12, 24 and 60 months respectively. Duration of AF>24 months (hazard ratio HR: 3.09, 95% confidence interval CI: 1.51 to 6.32; p = 0.002), left atrial diameter≥40 mm (HR: 4.03, 95% CI: 1.88 to 8.65; p<0.001), early recurrence of AF (HR: 4.66, 95% CI: 2.25 to 9.63; p<0.001) independently predicted long-term recurrence of AF. There was no procedure-related death. One patient converted to median sternotomy because of uncontrolled bleeding. Two patients underwent perioperative cerebrovascular events. CONCLUSIONS: At nearly 5-year of clinical follow-up, single-procedure success rate of minimally invasive surgical PVI with GP ablation was 51.8% for paroxysmal AF, 28.2% for persistent AF, 28.6% for long-standing persistent AF after initial procedure. Patients with AF duration≤24 months, left atrial diameter<40 mm and no early recurrence of AF, had favorable outcomes.
Zheng et al. (Mon,) conducted a cohort in Atrial Fibrillation (n=139). Minimally invasive surgical pulmonary vein isolation, ganglionic plexi ablation, and left atrial appendage exclusion was evaluated on Single-procedure success (freedom from atrial fibrillation, atrial flutter, or atrial tachycardia off antiarrhythmic drugs) at 60 months. Minimally invasive surgical pulmonary vein isolation with ganglionic plexi ablation achieved an overall single-procedure success rate of 46.6% at 60 months, with higher success in paroxysmal (51.8%) compared to persistent (28.2%) atrial fibrillation.