Minimal Invasive Surgical Ablation For Lone Atrial Fibrillation From A Single Center Clinical Experience
SHAO YONG FENG, GU JIA XI, LIU HONG.
Department of Cardiovascular Surgery, The First Affiliated Hospital with Nanjing Medica, Nanjing, China.
Background:Minimally invasive approaches for surgical treatment have been advocated as a treatment option for stand-alone atrial fibrillation (AF). We investigate the clinical outcomes after minimally invasive surgical ablation of both paroxysmal and persistent/longstanding persistent AF.
Methods: A retrospective chart review was performed on 245 consecutive patients who underwent standalone video-assisted thoracoscopic surgery (VATS) ablation with Maze procedure and left atrial appendage exclusion for AF by an experienced thoracoscopic surgeon at the First Affiliated Hospital of Nanjing Medical University between 2011 and 2019. Neither patients with sinus rhythm nor AF received oral anticoagulant drugs after surgery. Kaplan-Meier survival curve and log-rank test was used to analyze the maintenance of sinus rhythm.
Results: Of patients in this study, median age was 62 years (IQR 56-68) and 64.5% (158/245) was male. Paroxysmal AF was present in 51% (125/245) and persistent/longstanding persistent AF was present in 49% (120/245). Patients combined with a history of hypertension (138/245), diabetes mellitus (34/245), and stroke (169/245). Patients had median baseline CHA2DS2-VASc score of 3.0 (IQR 2-4), HAS-BLED score of 3.0 (IQR 2-3). No deaths occurred during hospitalization and follow-up. At follow-up of median 36 months (IQR 22-53 months), AF-free survival rates were 45.50% (95%CI 29.7%-69.7%) among patients with paroxysmal AF and 15.1 (95%CI 6.6-35.7%) among patients with persistent AF (log-rank P <0.05). AF-free survival rates were 48.18% (95%CI 33.22%-69.9%) among patients with a history of stroke and were 17.44% (8.15-37.36%) among patients without (log-rank P=0.425). Of all patients, thromboembolic events occurred in only 4 patients (1.6%) at follow-up.
Conclusions: Minimally invasive epicardial ablation appears to be safe and effective treatments for AF. This approach is a promising alternative to anticoagulation for stroke prevention in patients suffering from AF. These data derived from observational studies should be verified with randomised data.
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