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Totally thoracoscopic ablation and post-procedural confirmation: Early results of a surgical-electrophysiological approach for long standing atrial fibrillation
Dong Seop Jeong, Kiick Sung, Ji-Hyuk Yang, Tae-Gook Jun, Young Tak Lee, Pyo Won Park.
Samsung Medical Center, Seoul, Korea, Republic of.

OBJECTIVE: Totally thoracoscopic ablation is a new approach in the treatment of atrial fibrillation (AF). We report the early results of a totally thoracoscopic ablation following post-procedural eletrophysiological (EP) back up in patients with long standing AF.
METHODS: Between February 2012 and November 2012, 22 patients underwent totally thoracoscopic ablation for AF. We enrolled the 16 patients who underwent post-procedural EP study after thoracoscopic ablation for long standing AF. Totally thoracoscopic ablation included pulmonary vein isolation, division of ligament of Marshall, ganglionated plexus ablation, creation of roof line and posterior lines, resection of left atrial appendage and verification of conduction block. Post-procedural EP study was conducted at 4th postoperative day after chest tube removal. Freedom AF was assessed by ECGs and Holter monitoring at postoperative 6 months.
RESULTS: There was no early mortality and no surgical complication except one prolonged pleural effusion due to chronic lung disease. Stroke occurred in one patient at postoperative 5th day who recovered completely despite sinus conversion. All patients showed no residual potentials around pulmonary veins in endocardial mapping execpt one patient who needed additional endocardial touch up to remove small potential around pulmonary veins. Post-procedural CTI ablation was performed for atrial tachycardia in one patient and then CTI ablations were routinely performed to prevent atrial tachyarrhythmias. One patient required permanent pacemaker due to sinus node dysfunction despite sinus conversion. All patients showed sinus rhythm in ECGs during follow up. Ten patients who underwent Holter monitoring showed normal sinus rhythm.
CONCLUSIONS: Totally thoracoscopic ablation following post-procedural EP study is a safe and successful procedure. Post-procedural CTI ablation may be effective in preventing from atrial tachyarrhythmia during follow up.


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