International Society For Minimally Invasive Cardiothoracic Surgery

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Thoracoscopic Radiofrequency Ablation: Box-lesion Technique, Is It Enough?
Andrea Steriovsky1, Ales Klvacek2, Tomas Skala1, Martin Simek1, Petr Santavy1.
1University Hospital, Olomouc, Czech Republic, 2Na Homolce Hospital, Prague, Czech Republic.

Background:We evaluated the outcomes of minimally invasive box-lesion ablation for the treatment of stand-alone atrial fibrillation (AFiB) in our institution.Methods: Prospective analysis of 65 patients (mean age of 62.7 years) who were scheduled for bilateral thoracoscopic ablation of either symptomatic paroxysmal (n=14; 21.5%) or long-standing persistent AFiB (n=51; 78.5%) from January 2014 to December 2017. The box-lesion procedure comprised bilateral pulmonary veins and left atrial posterior wall ablation using irrigated bipolar radiofrequency.Results: No severe ablation-related complications were observed (bleeding, myocardial infarction, stroke or death) during in-hospital stay. During 1-year follow-up, sinus rhythm was maintained in 44 patients (67.7%) with no need of antiarrhytmic drug therapy in 42 patients (64.6%). Fourteen patients out of 21 (21.5%) who suffered from after-procedure AFib recurrence underwent endocardial electrophysiological mapping. Completeness of conduction block which did not require additional catheter ablation was confirmed in only 4 of those patients (28.6%).Conclusion: Minimally invasive thoracoscopic box-lesion ablation is considered to be safe and effective method of stand-alone AFiB treatment. High risk of box-lesion incompleteness in patients with AFiB recurrence in our cohort justifies routine implementation of staged hybrid approach for all patients considering undergoing this procedure. Supported by MH CZ - DRO (FNOl, 00098892)

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