Thorascopic surgical pulmonary vein isolation and ganglionic plexi ablation achieved a 65% success rate (freedom from atrial tachyarrhythmia >30 seconds) at 1 year.
Cohort (n=45)
No
Does thorascopic bilateral radiofrequency pulmonary vein isolation and ganglionic plexi ablation prevent atrial tachyarrhythmia recurrence in patients with atrial fibrillation?
Minimally invasive surgical pulmonary vein isolation and ganglionic plexi ablation achieved a 65% single-procedure success rate at 1 year for atrial fibrillation.
BACKGROUND: The Cox Maze procedure for treatment of medically refractory atrial fibrillation (AF) is limited by its complexity and requirement for cardiopulmonary bypass. Long-term follow-up and success using criteria established by the Heart Rhythm Society/European Heart Rhythm Association/European Cardiac Arrhythmia Society consensus statement have not been reported for surgical AF ablation. We describe the results of using a thorascopic approach and radiofrequency energy to perform bilateral pulmonary vein isolation and left atrial ganglionic plexi ablation for treatment of AF. METHODS AND RESULTS: Forty-five (33 paroxysmal; 12 persistent) consecutive patients underwent thorascopic bilateral radiofrequency pulmonary vein isolation, ganglionic plexi ablation, ligament of Marshall ablation, and left atrial appendage exclusion by a single surgeon. Forty-three patients were prospectively followed without antiarrhythmic drugs for a minimum of 1 year with a 30-day continuous event monitor or pacemaker interrogation at 6 and 12 months. Failure was defined as any atrial tachyarrhythmia of >30 seconds' duration occurring >90 days after surgery. Mean follow-up was 516+/-181 days (202 to 858 days). Twenty-eight (65%) patients had no atrial tachyarrhythmia >30 seconds by 1 year, and 15 (35%) patients had atrial tachyarrhythmia recurrences by 1 year. Eight of 15 patients with recurrent AF had catheter ablation resulting in elimination and/or reduction of AF episodes in 7 of 8 patients. Four of 15 patients had AF elimination or reduction with antiarrhythmic drugs alone. Three patients did not benefit from surgery and received rate control only. There were no deaths; 1 phrenic nerve injury and 2 pleural effusions were the only major complications. CONCLUSIONS: The single procedure success at 1-year follow-up for surgical pulmonary vein isolation and ganglionic plexi ablation is 65%. Atrial tachyarrhythmia recurrences after surgery are usually responsive to catheter ablation and/or antiarrhythmic drugs.
Han et al. (Wed,) conducted a cohort in Atrial fibrillation (n=45). Thorascopic bilateral radiofrequency pulmonary vein isolation and ganglionic plexi ablation was evaluated on Freedom from any atrial tachyarrhythmia >30 seconds duration occurring >90 days after surgery at 1 year. Thorascopic surgical pulmonary vein isolation and ganglionic plexi ablation achieved a 65% success rate (freedom from atrial tachyarrhythmia >30 seconds) at 1 year.