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OBJECTIVE: To evaluate the introduction of a closed chest stand alone AF ablation program for persistent AF compared to established catheter ablation.
METHODS: Patients with symptomatic persistent AF longer than a year in duration and refractory to pharmacological and electrical cardioversion, were recruited by patients’ choice to either surgical or catheter ablation. The surgical ablation technique involved a bilateral thoracoscopic approach for bilateral pulmonary vein isolation with dry bipolar radiofrequency clamps. Roof and inferior lines were created joining both sets of pulmonary veins using unipolar radiofrequency linear pen to form a box. Baseline pacing and conduction studies were performed before ablation on each pulmonary vein and the confluence. Bidirectional block was confirmed following ablation. High frequency stimulation of right sided ganglionic autonomic plexi was employed to guide subsequent ablation. On completion, a probe was also placed in the isolated box to confirm bidirectional block. Patients were left off antiarrhythmic drugs and monitored at 3, 6, and 12 month intervals with continuous monitoring. Failure was defined as any tachyarrhythmia longer than 30 seconds.
RESULTS: 50 patients were recruited and 21 patients were ablated in an 18 month period under the mentorship of an experienced operator. At 3, 6 and 12 months follow up, 14/17(82%), 13/16(81%) and 11/14(78%) respectively of the surgical group were free from AF/AT. This compared to 11/19(58%), 6/12(50%) and 2/6(33%) in the catheter ablation group. The long term follow-up was greater in the surgical group, but these initial results appear superior to catheter ablation supporting current literature.
CONCLUSIONS: Closed chest bilateral ablation can be safely introduced with mentorship achieving promising medium term results at a year when compared to single intervention catheter ablation technique.