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Right arrow Minimally invasive surgery

J Thorac Cardiovasc Surg 2009;137:521-526
© 2009 The American Association for Thoracic Surgery

Point/Counterpoint

Point: Minimally invasive bipolar radiofrequency ablation of lone atrial fibrillation: Early multicenter results

Erik Beyer, MDa, Richard Lee, MDb, Buu-Khanh Lam, MDc,*

a Scott and White Clinic, Temple, Texas
b Northwestern University, Chicago, Illinois
c University of Ottawa Heart Institute, Ottawa, Canada

Received for publication May 7, 2008; revisions received October 5, 2008; accepted for publication November 17, 2008.

* Address for reprints: Buu-Khanh Lam, MD, Division of Cardiac Surgery, University of Ottawa Heart Institute, 40 Ruskin St, H3404, Ontario, Canada, K1Y 4W7. (Email: bklam{at}ottawaheart.ca).

Objective: The treatment of lone atrial fibrillation can be a minimally invasive procedure using bipolar radiofrequency ablation technologies. Our objectives were to report on the safety and early efficacy of this novel therapeutic modality.

Methods: At 3 North American institutions between February 2005 and August 2007, 100 patients underwent minimally invasive bilateral pulmonary vein isolation, autonomic denervation, and left atrial appendage resection. The mean age was 65 ± 11 years, and 70% were male. The median duration of atrial fibrillation was 5.0 years; atrial fibrillation was paroxysmal in 39 patients (39%), persistent in 29 patients (29%), and permanent in 32 patients (32%). Indications for surgery included failure of medical therapy or percutaneous ablation and severe symptoms. Mean follow-up was 13.6 ± 8.2 months.

Results: The mean operative time was 253 ± 65 minutes, and the median hospital length of stay was 5 days. There were no intraoperative conversions and no mortality to report. Postoperative complications included pacemaker requirement in 5 patients (5%), phrenic nerve palsy in 3 patients (3%), hemothorax in 3 patients (3%), transient ischemic attack in 1 patient (1%), and pulmonary embolism in 1 patient (1%). At follow-up, 87% of patients were in normal sinus rhythm (paroxysmal 93%, persistent 96%, permanent 71%; P < .05); antiarrhythmic therapy was discontinued in 62% of patients, and anticoagulation therapy was discontinued in 65% of patients.

Conclusion: Minimally invasive bipolar radiofrequency ablation of lone atrial fibrillation is a safe and efficacious therapeutic option in selected patients. Further development is needed to reduce the rate of complications. Long-term prospective results are required to further validate this modality as a therapeutic option to treat lone atrial fibrillation.

Abbreviations and Acronyms AF = atrial fibrillation; AGP = autonomic ganglionic plexi; LA = left atrial; NSR = normal sinus rhythm; SR = sinus rhythm






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