Immediate results of thoracoscopic ablation for treatment of patients with lone atrial fibrillation

Background. Atrial fibrillation remains the most common sustained arrhythmia, with an expected increase in our aging population. In addition to the significant morbidity that is secondary to hemodynamic compromise and tachycardia-induced cardiomyopathy, stroke remains the most feared complication, with a 5-fold increased risk. New surgical approaches show promising results and perfect safety for treatment patients with different types of atrial fibrillation.Subject: to describe surgical technique and to evaluate the short-term efficacy and safety of radiofrequency thoracoscopic ablation (Dallas Lesion Set) in patients with lone atrial fibrillation.Material and Methods. Epicardial bipolar radiofrequency ablation was performed on the beating heart through a bilateral endoscopic approach in 127 consecutive patients with lone atrial fibrillation. This included isolation of the pulmonary veins using a clamp; isolation of the posterior left atrial wall, including a trigonal line to the aortic noncoronary sinus using a linear ablation device; and clip or resection of the left atrial appendage. Paroxismal atrial fibrillation was registered in 7% of patients; persistent and persistent long-standing atrial fibrillation was registered in 54 and 39% of patients respectively.Results. Mean duration of atrial fibrillation was 60 (24; 120) months. Mean operation time was 146.7±29.1 minutes. Complications rates were 24% during the learning curve period and 3.9% beyond this period. Freedom from atrial fibrillation and others rhythm disturbances was achieved in 90.5% of patients at discharge. Conclusion. Endoscopic radiofrequency ablation on the beating heart demonstrated high success rates in patients with all types of atrial fibrillation. The rates of complications and procedure-related morbidity decreased at times beyond the learning curve period.