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Eighteen-Months Follow-up after Thoracoscopic Isolated Ablation of Lone Atrial Fibrillation using a Epicardial, Beating-Heart Bipolar Ablation Device
Giuseppe Nasso1, Flavio Fiore1, Vito Romano1, Giuseppe Visicchio1, Giuseppe Greco1, Franco Massari2, Francesco Bartolomucci3, Khalil Fattouch4, Graziano Riccioni1, Giuseppe Speziale1.
1Anthea Hospital, GVM Hospitals of Care and Research, Bari, Italy, 2Division of Cardiology, Altamura Hospital, Altamura, Italy, 3ADivision of Cardiology, “L. Bonomo” Hospital, Andria, Italy, 4Division of Cardiac Surgery, Palermo University Hospital, Palermo, Italy.

Eighteen-Months Follow-up after Thoracoscopic Isolated Ablation of Lone Atrial Fibrillation using a Epicardial, Beating-Heart Bipolar Ablation Device
Objective. The minimally invasive ablation via right minithoracotomy is an emerging option for patients with refractory isolated atrial fibrillation. Despite encouraging clinical results, such epicardial, beating-heart strategy is limited by the heat sink effect from circulating blood at the endocardial surface. A novel device has been developed to perform bipolar and monopolar epicardial ablation on the beating heart. Herein we describe the average 18.1 ± 7 months clinical follow-up in a single-center experience.
Methods. This device is designed for off-pump epicardial ablation via right minithoracotomy or via ports by creation of a circular ‘box’ lesion around the four pulmonary vein orifices. Suction is applied in order to create a fold of the left atrial myocardium within the probe, and radiofrequency energy is thus delivered from both sides of the myocardial fold. As a result, the endocardial surface is drawn out of the cooling blood flow and a bipolar ablation is achieved. Since early 2012, such strategy was employed through videothoracoscopy in 21 patients. Follow-up consisted of 72-hours ECG Holter monitoring on a monthly basis.
Results. The procedure could be completed uneventfully in all cases, and all patients could be extubated within the 12th postoperative hour. The conduction block was verified routinely by temporary pacing of the left atrial dome, which revealed complete exit block in all instances. We recorded no cases of major or minor postoperative morbidity. The rate of discharge from the hospital in stable sinus rhythm was 95.3% (20 patients). At the latest available follow-up, 20 patients (90.5%) were in stable sinus rhythm and anticoagulant therapy had been withdrawn in 12 (57.1%) No thromboembolic events were recorded.
Conclusion. This mid-term experience suggests that the minimally invasive epicardial, beating-heart ablation of isolated atrial fibrillation is safe and feasible using the novel bipolar device. The heat sink effect can be minimized and the achievement of a transmural lesion is facilitated. Follow-up results may be superior than obtained with established, first-generation thoracoscopic devices (which did not allow bipolar ablation). Formal comparison studies are warranted.

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