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Minimal Invasive Totally Thoracoscopic Surgical Ablation for Atrial Fibrillation Using Box Lesion Set
Yingqiang Guo, Da Zhu.
West China hospital of Sichuan University, Chengdu, China.

OBJECTIVE: Minimally invasive surgical ablation is an emerging alternative method to catheter ablation and the full surgical maze procedure for non-pharmacologic treatment of atrial fibrillation. We presented a totally thoracoscopic bipolar “box lesion” radiofrequency ablation procedure in patients with paroxysmal or persistent atrial fibrillation.
METHODS: From June 2011 to October 2013, 23 patients (7 female) with lone paroxysmal (n=11) or persistent (n=12) atrial fibrillation were enrolled in this study. Procedures were performed through three 5-12mm holes on each side of the chest wall. A bipolar ablation device was used to create a box-lesion in the posterior wall of the left atrium that encircled the four pulmonary veins (achieving bilateral pulmonary vein/posterior left atrial wall isolation). Perioperative complications were recorded for all patients. Freedom from atrial fibrillation was assessed by 24h Holter monitoring every 3 months or during symptoms of arrhythmia.
RESULTS: The ablation was successfully performed in all patients with mean age 68.8±7.9 years old and LA volume 180±45cm2 measured by CT angiogram. The mean operation time of 65±25 minutes. One patient received two-stage hybrid operation combining trans-catheter as well as “box-lesion” ablation. No operative mortality or morbidity was noted during the study period. Freedom from atrial fibrillation was achieved in 19 patients (82.6%) during follow up (Mean follow-up time 1.5 years). One patient with persistent atrial fibrillation was shifted to paroxysmal atrial fibrillation. No atrial flutter or atrial tachycardia were noted during the follow-up.
CONCLUSIONS: These results show that totally thoracoscopic surgical ablation using a unique “box lesion” procedure for persistent or paroxysmal atrial fibrillation is a feasible and effective method with good short-term results. Further study is still necessary to validate this result.

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