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Long Term Follow-Up Following Minimally Invasive Surgical Ablation For Stand-Alone Atrial Fibrillation
Gianluigi Bisleri, Fabrizio Rosati, Lorenzo DI Bacco, Laura Giroletti, Claudio Muneretto.
University of Brescia Medical School, Brescia, Italy.

OBJECTIVE: Minimally invasive surgical treatment of atrial fibrillation (AF) has gained popularity during the past decade, however there is paucity of data about the long-term outcomes of this novel approach.
METHODS: Study population included 125 consecutive patients undergoing stand-alone surgical treatment of atrial fibrillation via a closed-chest, right-sided monolateral thoracoscopic approach (box lesion set) by means of a versapolar (combining uni/bipolar) radiofrequency ablation device. Mean age was 62,5 ± 10,4 yrs, and the prevalence of paroxysmal, persistent and long-standing(LS-persistent) AF was 37,6%, 11,2% and 51,2% respectively with a median AF duration of 60 months. Mean left atrial antero-posterior diameter was 48,6 ± 8,6 mm.
RESULTS: The procedure was successfully accomplished via an endoscopic approach in all patients except one requiring conversion to mini-sternotomy. Hospital mortality was 0% and no major complications occurred during the post-operative hospital stay except for a thrombo-embolic event occurring in 2 patients (1,6%). Multivariate Cox regression analysis identified long-standing persistent AF (OR:9.5;CI=2.5-35.4;p=0.001) and female gender (OR:3.03; CI=1.06-8.7;p=0.039) as independent risk factors for AF recurrence; instead, paroxysmal AF was associated with improved rhythm outcomes (OR:0.12;CI=0.04-0.36;p<0.001). At a median follow-up of 60 months, overall stable sinus rhythm was achieved in 79.2%(99/125 pts.) (paroxysmal: 91,5%, 43/47 pts.; persistent: 78,6%, 11/14 pts.; LS-persistent: 70,3%, 45/64 pts.); Finally, there was a trend towards the stabilization of rhythm over the follow-up time, as depicted by Spearman analysis showing a positive correlation among sinus rhythm restoration and follow-up duration (rho=0.82).
CONCLUSIONS: Totally endoscopic AF surgical ablation (box lesion) is a safe and effective procedure providing excellent and stable results over time at long-term follow-up. Rhythm outcomes in patients with LS-persistent AF may be further improved with an integrated hybrid approach.

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