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First-line Treatment Of Drug-refractory Persistent Atrial Fibrillation: Balloon Cryoablation Or Thoracoscopic Ablation?
Victor Vaykin, Mikhail Ryazanov, Dmitriy Zhiltsov, Anton Maximov, George Bolshukhin, Alishir Gamzaev, Oleg Demarin.
B. A. Korolev Specialized Clinical Cardiac Surgery Hospital, Nizhny Novgorod, Russian Federation.

BACKGROUND:The number of patients with persistent atrial fibrillation (AF) is increasing. What operation is better to offer them? The aim of the study was to compare in-hospital and mid-term results of balloon cryoablation and thoracoscopic epicardial ablation in persistent atrial fibrillation treatment.
METHODS:Two groups of patients were studied. The first group (G1) included 76 patients who underwent balloon cryoablation, the second one (G2) included 127 patients who underwent thoracoscopic ablation. G1 did not include patients with a duration of persistent AF more than 8 months and with left atrial diameter>4.5 cm. G2 had no restrictions on the timing of the occurrence of AF and the size of left atrium. Other characteristics: age, sex, BMI did not significantly differ in both groups. 24-Holter ECG monitoring was performed after 3, 6, and 12 months and annually thereafter.
RESULTS:One patient from G1 was discharged with AF, the rest with sinus rhythm. All patients in G2 were discharged with sinus rhythm. In-hospital stay was 31 days in G1 and 62 days in G2. In G1 one patient (1,3%) had cardiac tamponade that required pericardial puncture and 2 (2,6%) patients had hematomas of the lower extremities treated conservatively. Among the most significant complications in G2 were 2 (1,6%) cases of sinoatrial block that required pacemaker implantation, 2 (1,6%) relaxation of the right dome of the diaphragm and 23 (18,1%) cases of atrial flutter, stopped by catheter ablation of the cavatricuspid isthmus. In G1 sinus rhythm after 3, 6, 12 months was observed in 60 (78,9%), 54 (71%), 45 (59,2%) patients accordingly. After thoracoscopic ablation 117 (92,1%), 111 (87,4%), 105 (82,7%) patients had a sinus rhythm after 3, 6 and 12 months, respectively. Perioperative and follow-up mortality was 0 in each group.
CONCLUSIONS:The number of complications in both groups is small and they did not significantly affect the rehabilitation of patients. Thoracoscopic ablation showed higher efficacy in the treatment of persistent AF, however balloon cryoablation provides acceptable medium-term results, less surgical trauma and hospital stay.

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