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Pulmonary vein anatomy impact to long-term results of surgical minimally invasive ablation of persistent and long standing persistent atrial fibrillation using bipolar radiofrequency ablation device. Case series of 75 patients.
Vilius Janusauskas1, Lina Puodziukaite1, Greta Radauskaite1, Aleksejus Zorinas1, Mindaugas Mataciunas2, Sigita Aidietiene1, Kestutis Rucinskas1, Audrius Aidietis1.
1Department of Cardiovascular Medicine, Vilnius University Medicine Faculty, Vilnius, Lithuania, 2Department of Radiology, Vilnius University Medicine Faculty, Vilnius, Lithuania.
OBJECTIVE: In our study we wanted to check if PV anatomy is related with long-term results of minimally invasive surgical ablation.
METHODS: This observational, retrospective study included 75 patients who underwent minimally invasive stand-alone surgical epicardial ablation for non-valvular, persistent or long standing persistent AF and had available preoperative multi-detector row CT scans. The box isolation of PV’s was created using a bipolar radiofrequency clamp. Only patients with confirmed PV isolation were included in the evaluation. Absence of arrhythmia was confirmed at 3, 6, and 12 months and annually thereafter with 24-h Holter monitoring. A PV classification based on both the number of venous ostia on each side and the drainage patterns of PV, was used.
RESULTS: 67 (89%) patients had usual left side PV drainage pattern (two pulmonary veins, left common trunk less than 1cm). 8(11%) patients had unusual left side PV drainage pattern (common trunk more than 1cm or three left side PV). Patients with unusual left side PV drainage more frequently had AF reoccurrence at long term follow up (χ2=5,176, p=0,023). Only 15(20%) patients had late PV (more than 1cm) division on right side. The seven patients (8%) who had usual left side PV drainage pattern and had late PV division on right side had the highest rate of sinus rhythm at long term follow up (χ2=4,598, p=0,032). There were no other significant differences between those patient groups.
CONCLUSIONS: PV anatomy is related with related with long-term results of minimally invasive surgical ablation for persistent or long standing persistent AF then bipolar radofrequency ablation clamp is used. 
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