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TORACOSCOPIC APPROACH IN THE TREATMENT OF PATIENTS WITH ATRIAL FIBRILLATION: 1-YEAR FOLLOW-UP THROUGH CONTINUOUS SUBCUTANEOUS MONITORING
Evgeny Pokushalov, Alexander Romanov, Dmitry Elesin, Alexander Bogachev-Prokophiev, Denis Losik, Sevda Bairamova.
State Reserch Institute Circulation Pathology, Novosibirsk, Russian Federation.
OBJECTIVE: The aim of this prospective observational study was to identify Responders thoracoscopic ablation through continuous subcutaneous monitoring for 1 year after ablation.
METHODS: Bilateral video-assisted thoracoscopy was performed to isolate both pairs of pulmonary veins, create box-lesion, to ablate the ganglionic plexus and amputate the left atrial appendage. Preoperative, in-hospital and follow-up data were collected for our first 60 patients. All patients were implanted with Reveal XT (Medtronic Inc.) for continuous AF monitoring and data collected every month during the 12-month follow-up. Paroxysmal AF was in 26%, persistent in 50% and permanent in 24% of cases. The mean (±SD) left atrial diameter was 48.1±7.4 mm and the mean duration of AF was 79.0±63.9 months
RESULTS: Mean operation time was 137.4±24.7 min. All patients were extubated in the operating room and left the recovery room within 12 h. The mean hospital stay was 6.1±1.8 days. Postoperative mortality was 0%. Freedom from AF was 84%, 75% and 33% for paroxysmal, persistent and permanent AF, respectively ( p > 0.05), i.e., AF% < 0.5% according to subcutaneous continuous monitoring datas at 12 month follow up.
CONCLUSIONS: Thoracoscopic ablation is highly effective in treating AF, as assessed through detailed 1-year continuous monitoring: success rate is higher in PAF than in PersAF patients. The use of subcutaneous monitors is a valuable means of identifying responders and nonresponders, and can potentially guide antiarrhythmic and antithrombotic therapies.
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