HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Correction (v131,p772) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Randall K. Wolf Walter Merrill John B. Flege, Jr Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Wolf, R. K. Articles by Gillinov, A. M. Search for Related Content PubMed PubMed Citation Articles by Wolf, R. K. Articles by Gillinov, A. M. Related Collections Cardiac - other Electrophysiology - arrhythmias Minimally invasive surgery

J Thorac Cardiovasc Surg 2005;130:797-802
© 2005 The American Association for Thoracic Surgery

Evolving Technology

Video-assisted bilateral pulmonary vein isolation and left atrial appendage exclusion for atrial fibrillation

^a Section of Cardiothoracic Surgery at The University of Cincinnati College of Medicine, Cincinnati, Ohio
^b Department of Thoracic and Cardiovascular Surgery at The Cleveland Clinic Foundation, Cleveland, Ohio.

Received for publication November 1, 2004; revisions received March 11, 2005; accepted for publication March 31, 2005.

^_* Address for reprints: Randall K. Wolf, MD, The University of Cincinnati College of Medicine, Medical Sciences Building, 231 Albert B. Sabin Way, PO Box 670558, Cincinnati, OH 45267 (Email: wolfr{at}ucmail.uc.edu).

OBJECTIVE: Pulmonary vein isolation is curative in selected patients with atrial fibrillation. The objective of this study was to assess the feasibility and safety (midterm results) of video-assisted thoracoscopic epicardial pulmonary vein isolation.

METHODS: Twenty-seven patients (22 male patients) with atrial fibrillation (18 paroxysmal, 4 persistent, and 5 permanent; average age, 57 years) underwent bilateral video-assisted thoracoscopic off-pump epicardial pulmonary vein isolation and exclusion of the left atrial appendage. All patients had had unsuccessful drug therapy or were intolerant to antiarrhythmic drug therapy or were intolerant to warfarin. The approach included two 10-mm ports and one 5-cm working port (non–rib spreading) bilaterally. Pulmonary vein isolation was achieved bilaterally by using a bipolar radiofrequency device. The left atrial appendage was excised with a surgical stapler.

RESULTS: Bilateral pulmonary vein isolation and left atrial appendage excision was performed successfully in all patients. There were no conversions to sternotomy or thoracotomy. All patients were extubated in the operating room. Postoperative complications in 3 patients were minor and resolved within 48 hours. One morbidly obese patient had more serious complications related to comorbid conditions. Average postoperative follow-up is approximately 6 months (173.6 days). Twenty-three patients have been followed up for greater than 3 months, and 21 of these patients are free of atrial fibrillation (91.3%). The results of magnetic resonance angiography were normal (no pulmonary vein stenosis) in 12 of 12 patients evaluated 3 to 6 months postoperatively.

CONCLUSIONS: Bilateral video-assisted thoracoscopic pulmonary vein isolation with excision of the left atrial appendage is feasible and safe and offers a promising, new, minimally invasive, beating-heart approach for curative surgical treatment of atrial fibrillation.

This article has been cited by other articles:

				S. C. Lall, K. V. Foyil, S.-I. Sakamoto, R. K. Voeller, J. P. Boineau, R. J. Damiano Jr., and R. B. Schuessler Pulmonary vein isolation and the Cox maze procedure only partially denervate the atrium. J. Thorac. Cardiovasc. Surg., April 1, 2008; 135(4): 894 - 900. [Abstract] [Full Text] [PDF]

				J. A. Cabrera, S. Y. Ho, V. Climent, and D. Sanchez-Quintana The architecture of the left lateral atrial wall: a particular anatomic region with implications for ablation of atrial fibrillation Eur. Heart J., February 1, 2008; 29(3): 356 - 362. [Abstract] [Full Text] [PDF]

				J. H. Wudel, P. Chaudhuri, and J. J. Hiller Video-Assisted Epicardial Ablation and Left Atrial Appendage Exclusion for Atrial Fibrillation: Extended Follow-Up Ann. Thorac. Surg., January 1, 2008; 85(1): 34 - 38. [Abstract] [Full Text] [PDF]

				R. K. Voeller, R. B. Schuessler, and R. J. Damiano Jr. Surgical Treatment of Atrial Fibrillation Card. Surg. Adult, January 1, 2008; 3(2008): 1375 - 1394. [Full Text]

				H. Calkins, J. Brugada, D. L. Packer, R. Cappato, S.-A. Chen, H. J.G. Crijns, R. J. Damiano Jr, D. W. Davies, D. E. Haines, M. Haissaguerre, et al. HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Personnel, Policy, Procedures and Follow-Up: A report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation Developed in partnership with the European Heart Rhythm Association (EHRA) and the European Cardiac Arrhythmia Society (ECAS); in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), and the Society of Thoracic Surgeons (STS). Endorsed and Approved by the governing bodies of the American College of Cardiology, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, and the Heart Rhythm Society. Europace, June 1, 2007; 9(6): 335 - 379. [Full Text] [PDF]

				E. Sagbas, B. Akpinar, I. Sanisoglu, B. Caynak, B. Tamtekin, K. Oral, and B. Onan Video-Assisted Bilateral Epicardial Pulmonary Vein Isolation for the Treatment of Lone Atrial Fibrillation Ann. Thorac. Surg., May 1, 2007; 83(5): 1724 - 1730. [Abstract] [Full Text] [PDF]

				J. Puskas, E. Lin, D. Bailey, and R. Guyton Thoracoscopic Radiofrequency Pulmonary Vein Isolation and Atrial Appendage Occlusion Ann. Thorac. Surg., May 1, 2007; 83(5): 1870 - 1872. [Abstract] [Full Text] [PDF]

				J. R. Mehall, R. M. Kohut Jr, E. W. Schneeberger, T. Taketani, W. H. Merrill, and R. K. Wolf Intraoperative Epicardial Electrophysiologic Mapping and Isolation of Autonomic Ganglionic Plexi Ann. Thorac. Surg., February 1, 2007; 83(2): 538 - 541. [Abstract] [Full Text] [PDF]

				O. Onalan and E. Crystal Left Atrial Appendage Exclusion for Stroke Prevention in Patients With Nonrheumatic Atrial Fibrillation Stroke, February 1, 2007; 38(2): 624 - 630. [Abstract] [Full Text] [PDF]

				H. Jeanmart, F. Casselman, R. Beelen, F. Wellens, I. Bakir, F. Van Praet, G. Cammu, Y. Degriek, Y. Vermeulen, and H. Vanermen Modified Maze During Endoscopic Mitral Valve Surgery: The OLV Clinic Experience Ann. Thorac. Surg., November 1, 2006; 82(5): 1765 - 1769. [Abstract] [Full Text] [PDF]

				S. Benussi and O. Alfieri Off-pump connection of the pulmonary veins with bipolar radiofrequency: Toward a complete epicardial ablation J. Thorac. Cardiovasc. Surg., July 1, 2006; 132(1): 177 - 178. [Full Text] [PDF]

				J. Q. Melo Surgery for atrial fibrillation: Are we heading in the right direction? J. Thorac. Cardiovasc. Surg., May 1, 2006; 131(5): 949 - 951. [Full Text] [PDF]