Thoracoscopic Ablation for Atrial Fibrillation: Does Sinus Rhythm Self-restoration During Ablation Increase Success Rates?
Victor Vaykin, Zhilcov Dmitriy, Mikhail Ryazanov, George Bolshukhin
B. A. Korolev Specialized Clinical Cardiac Surgery Hospital, Nizhny Novgorod, Russian Federation
BACKGROUND: The number of thoracoscopic ablations is steadily increasing. The aim of the study was to investigate the effectiveness and safety of thoracoscopic radiofrequency ablation for different forms of atrial fibrillation and evaluate whether independent recovery of sinus rhythm during ablation affects the effectiveness of the operation in the long-term period
METHODS: 106 patients who underwent thoracoscopic ablation from 2015 to 2020 were analyzed. The median age was 56.3 years. The average body mass index was 30.4. 74 (69.8%) patients had persistent and long-standing forms of atrial fibrillation, the remaining 32 (30.2%) had paroxysmal atrial fibrillation. 34 (32%) patients had previously undergone catheter ablation. The size of the left atrium was increased to 54/66 mm. Every procedure included bilateral pulmonary vein isolation. For the first 3 months, patients received antiarrhythmic and anticoagulant therapy. In the absence of the recurrence of atrial fibrillation, antiarrhythmic therapy was canceled. After six months, anticoagulant therapy was also canceled. 24-Holter ECG monitoring was performed after 3, 6, and 12 months and annually thereafter. The average follow-up period was 21.5 months
RESULTS: In the immediate postoperative period, all patients maintained a sinus rhythm. 14 patients out of 74 who had persistent AF had self-restoration to the sinus rhythm during ablation, the remaining 60 required electrical cardioversion. Of these 14 patients, 5 had a recurrence of arrhythmia in different periods of follow-up. The total number of arrhythmia recurrences was 16 cases. Among the most significant complications are 2 cases of sinoatrial block that required pacemaker implantation, 1 relaxation of the right dome of the diaphragm and 18 cases of atrial flutter, stopped by catheter ablation of the cavatricuspid isthmus
CONCLUSIONS:The effectiveness of thoracoscopic ablation is 85%. The number of complications is small and they did not significantly affect the rehabilitation of patients. Self-restoration of the sinus rhythm during ablation is not a predictor of the effectiveness of the operation. A third of patients in this group had a recurrence of AF