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. 2014 Jan;3(1):38-44.
doi: 10.3978/j.issn.2225-319X.2013.12.10.

Effectiveness and safety of simultaneous hybrid thoracoscopic and endocardial catheter ablation of lone atrial fibrillation

Laurent Pison  1 , Sandro Gelsomino  2 , Fabiana Lucà  1 , Orlando Parise  1 , Jos G Maessen  1 , Harry J G M Crijns  2 , Mark La Meir  1
Affiliations

Effectiveness and safety of simultaneous hybrid thoracoscopic and endocardial catheter ablation of lone atrial fibrillation

Laurent Pison et al. Ann Cardiothorac Surg. 2014 Jan.

Abstract

Background: We evaluated the safety and effectiveness of the hybrid thoracoscopic endocardial epicardial technique for the treatment of lone atrial fibrillation.

Methods: Between 2009 and 2012, a cohort of 78 consecutive patients (median age 60.5 years, 77% male) underwent ablation of atrial fibrillation (AF) as a stand-alone procedure using a thoracoscopic, hybrid epicardial-endocardial technique. All patients underwent continuous 7-day Holter monitoring at 3 months, 6 months, 1 year and yearly thereafter. All patients reached 1-year follow-up. Median follow-up was 24 months [interquartile range 12-36].

Results: No death or conversion to cardiopulmonary bypass occurred. No patient demonstrated paralysis of the phrenic nerve. Overall, the incidence of perioperative complications was 8% (n=6). At the end of follow-up, sixty-eight patients (87%) were in sinus rhythm (SR) with no episode of AF, atrial flutter or atrial tachycardia lasting longer than 30 seconds and off antiarrhythmic drugs (ADD). Among patients with long-standing persistent AF, 15 (100%) were in SR and off AAD. Success rates were 82% (n=28) in persistent and 76% (n=22) in paroxysmal AF (P=0.08). No patient died and no thromboembolic/bleeding events or procedure-related complications occurred during the follow-up.

Conclusions: Thoracoscopic hybrid epicardial endocardial technique proved to be effective and safe in the treatment of LAF and to represent an important new suitable option to treat stand-alone AF. Our findings need to be confirmed by further larger studies.

Keywords: Atrial fibrillation (AF); ablation; surgery.

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Figures

Figure 1
Figure 1
Success rate off antiarrhythmic drugs (Off-ADD).
Figure 2
Figure 2
Success rate on antiarrhythmic drugs (AAD).
Figure 3
Figure 3
Single-procedure success rate.
See this image and copyright information in PMC

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