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International Society For Minimally Invasive Cardiothoracic Surgery

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Does Superior Pulmonary Vein Dissection Improve Thoracoscopic Ablation?
Pavel A. Shilenko, Yurii А Schneider, Men D. Tsoy, Mikhail S. Fomenko, Aleksander A. Pavlov.
FCHMT Kaliningrad, Kaliningrad, Russian Federation.

Objective: in the mapping of the left atrial after epicardial ablation there are a lot of data about gaps around left superior pulmonary vein. Obviously, the Marshall ligament is an important link in the source and preservation of atrial fibrillation. Does the destruction of pericardial leaves between the superior pulmonary veins affect the interruption of atrial fibrillation? Methods: from January 2015 to December 2019 297 patients were made totally thoracoscopic bilateral pulmonary vein isolation, roof and floor lesions and additional lines. The average age was 61.5 years (35-81 years). Thirty people had a prior stroke. The average volume left atrium was 141 ml. 268 (90,2%) patients were with persistent atrial fibrillation. 21 (7.7%) were made prior endocardial ablation. 123 operations performed according to the classical method. 174 operations with destruction of pericardial leaves between the superior pulmonary veins. For exclude left atrial appendage, we’ve made tourniquet left atrial appendage ligation. Periodic holter monitoring for determing freedom from atrial fibrillation were performed. Results: in the group without destruction of pericardial leaves between the superior pulmonary veins the rates of interruption of atrial fibrillation was 23(18.7%): 11 cases (10%) the rhythm was transformed to atrial flutter, in 12(11.1%) - sinus rhythm. In the group with complete pulmonary vein dissection the interruption of atrial fibrillation was observed in 89 cases (51.3%): 53 (30.4%) transformation in atrial flutter, and 32 (18.4%) rhythm was transformed to sinus rhythm. Summary interruption of fibrillation in two groups was observed in 112 patients (37.7%).
Conclusions: an increase in the number of heart rhythm transformation by more than 2 times, shows the importance of the destruction of the duplication of the leaves of the pericardium between the superior pulmonary veins. Further study of the results will show the difference in the effectiveness of freedom from atrial fibrillation.


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