Document Detail


Thoracoscopic video-assisted pulmonary vein antrum isolation, ganglionated plexus ablation, and periprocedural confirmation of ablation lesions: first results of a hybrid surgical-electrophysiological approach for atrial fibrillation.
MedLine Citation:
PMID:  21493960     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Thoracoscopic pulmonary vein isolation (PVI) and ganglionated plexus ablation is a novel approach in the treatment of atrial fibrillation (AF). We hypothesize that meticulous electrophysiological confirmation of PVI results in fewer recurrences of AF during follow-up.
METHODS AND RESULTS: Surgery was performed through 3 ports bilaterally. Ganglionated plexi were localized and subsequently ablated. PVI was performed and entry and exit block was confirmed. Additional left atrial ablation lines were created and conduction block verified in patients with nonparoxysmal AF. The left atrial appendage was removed. Freedom of AF was assessed by ECGs and Holter monitoring every 3 months or during symptoms of arrhythmia. Antiarrhythmic drugs were discontinued after 3 months and oral anticoagulants were discontinued according to the guidelines. Thirty-one patients were treated (16 paroxysmal AF, 13 persistent AF, 2 long-standing persistent AF). Thirteen patients with nonparoxysmal received additional left atrial ablation lines. After 1 year, 19 of 22 patients (86%) had no recurrences of AF, atrial flutter, or atrial tachycardia and were not using antiarrhythmic drugs (11/12 paroxysmal, 7/9 persistent, and 1/1 long-standing persistent). Three patients had a sternotomy because of uncontrolled bleeding during thoracoscopic surgery. Four adverse events were 1 hemothorax, 1 pneumothorax, and 2 pneumonia. No thromboembolic complications or mortality occurred.
CONCLUSIONS: Thoracoscopic surgery with PVI and ganglionated plexus ablation for AF is a safe and successful procedure with a single procedure success rate of 86% at 1 year. Electrophysiological guided thorough PVI and additional left atrial ablation line creation presumably contributes in achieving a high success rate in the surgical treatment of AF.
Authors:
Sébastien P J Krul; Antoine H G Driessen; Wim J van Boven; André C Linnenbank; Guillaume S C Geuzebroek; Warren M Jackman; Arthur A M Wilde; Jacques M T de Bakker; Joris R de Groot
Publication Detail:
Type:  Comparative Study; Journal Article; Research Support, Non-U.S. Gov't     Date:  2011-04-14
Journal Detail:
Title:  Circulation. Arrhythmia and electrophysiology     Volume:  4     ISSN:  1941-3084     ISO Abbreviation:  Circ Arrhythm Electrophysiol     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-06-15     Completed Date:  2011-09-01     Revised Date:  2012-02-03    
Medline Journal Info:
Nlm Unique ID:  101474365     Medline TA:  Circ Arrhythm Electrophysiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  262-70     Citation Subset:  IM    
Affiliation:
Heart Failure Research Center, Department of Cardiology and Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Atrial Appendage / physiopathology,  surgery*
Atrial Fibrillation / physiopathology,  surgery*
Autonomic Denervation / methods*
Catheter Ablation / methods*
Electrocardiography, Ambulatory
Electrophysiological Phenomena
Female
Follow-Up Studies
Ganglia, Autonomic / surgery*
Humans
Male
Middle Aged
Pulmonary Veins / physiopathology,  surgery*
Retrospective Studies
Thoracoscopy / methods*
Treatment Outcome
Comments/Corrections
Comment In:
Circ Arrhythm Electrophysiol. 2011 Jun;4(3):255-6   [PMID:  21673022 ]
Nat Rev Cardiol. 2011 Jun;8(6):303   [PMID:  21544047 ]

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