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MID TERM RESULTS OF THE MINIMALLY INVASIVE SURGICAL ABLATION OF PERSISTENT AND PERMANENT ATRIAL FIBRILATION.
Martin Michel, Stepan Cerny, Jozef Petrus, Jan Petrů, Petr Neužil.
Na Homolce Hospital, Prague, Czech Republic.

OBJECTIVE:
In the field of persistent and permanent atrial fibrillation/AF/ the results of catheter ablation are less satisfying. Very good results has been recently published with the surgical ablation using cryoenergy and limited incisions
METHODS: We performed prospective nonrandomized single center study of consecutive patients with symptomatic persistent or permanent AF undergoing miniinvasive surgical ablation procedure. The procedure consisted of endocardial cryoablation of left or both atria and left atrial appendage occlusion via right small anterolateral thoracotomy using full cardiopulmonary bypass and cardioplegic cardiac arrest
RESULTS: Between July 2008 and October 2011 we performed 30 surgical ablations of AF. It concerned 28 males and 2 females with the average age of 57,9 ± 7,5 years (range 46-76 years). The average duration of arrhytmia before the surgical intervention was 85,58 ± 85,41 months (range 9 - 432). None of the patiens have died. The average period of follow up was 36,2± 8,9 months (12-51 months). During the latest clinical control 86% of patiens (25/29) have had stable sinus rhythm /SR/ which has been verified by 7-days Holter ECG monitoring. The follow up limit of 36 months has been completed by 17 patients out of which 15 (88%) have had SR. In 92% patiens with SR good mechanical function of the left atrium was detected by Transthoracic echocardiography (TTE). Significant reduction of the left atrial diameter comparing to the preoperative size was also detected by the TTE 49 + 4,6 vs. 45 + 4,8 (p<0,001). CT angiography of the heart has proven a complete closure of left atrial appendage in all of the patiens. During the follow up none of the patiens has suffered a stroke. The NYHA class was improved significantly comparing to the preoperative status 2 + 0,6 vs. 1 + 0,5 (p<0,001)
CONCLUSIONS: The 88% success rate at 36 months confirmed by long-term monitoring is far better than any results published with the catether ablation of chronic AF. This technique thanks to its radicality has the potential to substitude the catheter ablation, mainly within the population of younger patients with low surgical risks.


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