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J Thorac Cardiovasc Surg 2009;137:1265-1271
© 2009 The American Association for Thoracic Surgery

Evolving Technology

Epicardial off-pump pulmonary vein isolation and vagal denervation improve long-term outcome and quality of life in patients with atrial fibrillation

Louise Bagge, MDa,*, Per Blomström, MD, PhDa, Leif Nilsson, MD, PhDb, Gunnar Myrdal Einarsson, MD, PhDb, Lena Jidéus, MD, PhDb, Carina Blomström-Lundqvist, MD, PhDa

a Department of Cardiology, Uppsala University Hospital, Uppsala, Sweden
b Department of Thoracic Surgery, Uppsala University Hospital, Uppsala, Sweden

Received for publication August 14, 2008; revisions received November 19, 2008; accepted for publication December 19, 2008.

* Address for reprints: Louise Bagge, MD, Department of Cardiology, Uppsala University Hospital, 751 85 Uppsala, Sweden. (Email: louise.bagge{at}medsci.uu.se).

Objectives: The limited information available on thoracoscopic pulmonary vein isolation combined with ganglionated plexi ablation and the lack of studies regarding its effect on quality of life and physical capacity urged us to study its acute and long-term results in patients with atrial fibrillation.

Methods: Forty-three patients (mean age 57.1 years) with symptomatic atrial fibrillation referred for thoracoscopic off-pump epicardial pulmonary vein isolation and ganglionated plexi ablation using radiofrequency energy were included.

Results: The physical capacity improved significantly at 6-month follow-up compared with baseline (mean ± standard deviation, 165.2 ± 65 Watt versus 155.9 ± 57 Watt, P = .02). Quality of life (Short Form-36 health survey) significantly improved 12 months after surgery compared with baseline in all subscales except for bodily pain. The symptom severity questionnaire score decreased significantly from mean 15.2 ± 4.0 points to 10.7 ± 4.8 points (P = .02). Overall, 25 of 33 patients (76%) followed up for 12 months had no symptomatic atrial fibrillation recurrences or atrial fibrillation episodes on 24-hour Holter recordings. The corresponding figures were 79% (19/24) for patients with paroxysmal atrial fibrillation, 100% (2/2) for persistent atrial fibrillation, and 57% (4/7) for permanent atrial fibrillation. The most common complication was bleeding events (9%) during pulmonary vein dissection.

Conclusions: Epicardial off-pump pulmonary vein isolation combined with ganglionated plexi ablation improved quality of life, symptoms, and exercise capacity and therefore may be considered for patients with atrial fibrillation who fail endocardial pulmonary vein ablation or as a first-line procedure if left atrial appendage exclusion is warranted.

Abbreviations and Acronyms AAD = antiarrhythmic drug; AF = atrial fibrillation; CT = contrast tomography; ECG = electrocardiogram; GP = ganglionated plexi; LAA = left atrial appendage; PV = pulmonary vein; QoL = quality of life; RF = radiofrequency; SSQ = symptom severity questionnaire






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