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Thoracoscopic radiofrequency ablation for lone atrial fibrillation: box-lesion set experience
Marek Pojar1, Jan Vojacek1, Ludek Haman2, Petr Parizek2, Jan Harrer1.
1Department of Cardiac Surgery, Charles University in Prague, Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic, 21st Department of Cardiovascular Medicine, Charles University in Prague, Faculty of Medicine and University Hospital, Hradec Kralove, Czech Republic.

OBJECTIVE: Atrial fibrillation is the most common arrhythmia. We report the feasibility and results of totally thoracoscopic box-lesion ablation technique to treat stand-alone atrial fibrillation.
METHODS: Between May 2009 and November 2012, 32 patients (25 male), mean age 57.2±8.9 years (range, 44-73 years) with lone atrial fibrillation refractory for antiarrhythmic drugs underwent the procedure. Twenty patients (62.5%) had symptomatic paroxysmal atrial fibrillation, while five (15.6%) had persistent and seven (21.9%) long-standing persistent atrial fibrillation. The median duration of atrial fibrillation was 50 months (7-240). The approach included two 11-mm ports and one 5-mm port. Box-lesion set ablation procedure included bilateral pulmonary vein ablation together with the posterior wall of the left atrium using irrigated bipolar radiofrequency with the documentation of exit block. Closure of the left atrial appendage was performed in 2 patients. All patients were followed-up after the ablation including Holter ECG monitoring.
RESULTS: There was no intra- or perioperative ablation related complication. There were also no operative mortality, no myocardial infarction, and no stroke. Skin-to-skin procedure time was 119.4±25.8 minutes and the postoperative average hospital stay was 7.3±2.7 days. Sinus rhythm was restored in 29 (90%) patients while 10% remained in paroxysmal atrial fibrillation at the discharged. After a mean follow-up of 107±23 days, the single-procedure success rate was 76%. In the next period 21% patients underwent catheter re-ablation. At the last postoperative control, median follow-up 280 (86-1112) days, 90% patients were in sinus rhythm. Pleural effusions occurred in one patient postoperatively.
CONCLUSIONS: Thoracoscopic box-lesion ablation procedure is a safe and effective, less invasive method for treatment of isolated (lone) atrial fibrillation. The operation provides excellent short-term freedom from atrial fibrillation.


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