Long Term Efficacy And Safety Of Epicardial Ablation For Paroxysmal Atrial Fibrillation
Bryan Miles1, Dr. Mina Mehanni1, Anna Sudbury2, Dr. John Johnkoski3.
1Medical College of Wisconsin, Wauwatosa, WI, USA, 2Medical College of Wisconsin, Wausau, WI, USA, 3Aspirus Heart and Lung Surgery, Wausau, WI, USA.
Background:Catheter ablation is the cornerstone of treatment for paroxysmal atrial fibrillation (AF). Alternative techniques have been developed, such as minimally invasive epicardial ablation. The aim of this study is to report the efficacy and safety of thoracoscopic epicardial left atrial ablation (TELA) procedure in patients with paroxysmal AF. Methods:Between 04/2011 and 06/2017, 56 patients (77% males) with paroxysmal AF (mean CHA2DS2-VASc2 Score 2.0 +/- 1.6) underwent TELA, including bilateral pulmonary vein isolation, ganglia mapping and ablation, left atrial dome lesions, superior vena cava lesion, and left atrial appendage exclusion. All patients received an internal loop recorder, 30 days post-operatively. Antiarrhythmic and anticoagulation therapy were discontinued at 90 and 180 days postoperatively, respectively, if patients were free of atrial fibrillation recurrence. Failure was defined as greater than or equal to 2 minutes of continuous atrial fibrillation or flutter on any internal loop recorder download. Results:During the follow-up period (36.8 +/- 21.1 months), 66% of patients (n=37) were free of AF, atrial flutter or tachycardia recurrence. Success rates were 88% (n=49), 84%(n=47), 77%(n=43), 70%(n=39), 68%(n=38), 66%(n=37) at six months, one, two, three four and five years respectively. One patient experienced SVC injury during the procedure and recovered without complications. Otherwise, no major procedural complications occurred in this group of patients, including major bleeding, cardiovascular or cerebrovascular events. Conclusions:In this single center experience, TELA was an efficacious procedure for patients with paroxysmal AF and seemed to be safe. 
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