Totally Thoracoscopic Ablation In Patients With Atrial Fibrillation After Failed Catheter Ablation
Joo Yeon Kim, Young Keun On, Dong Seop Jeong.
Samsung Medical Center, Seoul, Korea, Republic of.
BACKGROUND The number of patients referred for totally thoracoscopic ablation is increasing after failed catheter ablation to treat atrial fibrillation (AF) because of its less invasiveness and high success rate. However, the efficacy of totally thoracoscopic ablation in these patients remains unknown. We investigated the impact of previous catheter ablation on mid-term outcomes of totally thoracoscopic ablation. METHODS Between February 2012 and July 2018, 332 patients underwent totally thoracoscopic ablation for the treatment of AF (persistent = 264 (80%)). Patients were grouped by the presence (the CA group; n=47; 14%) or absence (the nCA group; n=285; 86%) of previous catheter ablation history. All patients were followed up at 3, 6, and 12 months and annually thereafter with 24-holter monitoring. The median follow-up duration was 24.3 months. RESULTS Patient in the CA group had significantly smaller left atrial volume index (49ml/m2 versus 40ml/m2; P=0.001) and were more likely to have paroxysmal AF compared with those in the nCA group. All baseline characteristics and risk factors were similar between the groups. No intergroup difference was observed in early and late complications such as bleeding, pericarditis, pacemaker insertion or embolic stroke. At late follow up, normal sinus rhythm was observed 92% patients (43/47) in the CA group (versus 85% (242/285) in the nCA group; P=0.268). Freedom from AF recurrence and antiarrhythmic drugs at 5 year was 55.3±11.0% in the CA group which was similar to the nCA group (55.7±5.1%; P=0.690). On the Cox regression analysis, preoperative brain natriuretic peptide (hazard ratio 1.02; P=0.014) and left atrial volume index (hazard ratio 1.04; P=0.003) were associated with AF recurrence after totally thoracoscopic ablation but previous catheter ablation history was not significant (hazard ratio 1.68; P=0.142). CONCLUSIONS Totally thoracoscopic ablation was safe and effective in treating AF irrespective of previous catheter ablation history. Previous catheter ablation did not appear to affect procedural complexity or success rate of thoracoscopic ablation.
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