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) 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 Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): James R. Edgerton David Duke Marc W. Gerdisch Bryan M. Steinberg Scott H. Bronleewe Syma L. Prince Morley A. Herbert Michael J. Mack Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Edgerton, J. R. Articles by Mack, M. J. Search for Related Content PubMed Articles by Edgerton, J. R. Articles by Mack, M. J. Related Collections Cardiac - physiology Electrophysiology - arrhythmias

J Thorac Cardiovasc Surg 2009;138:109-114
© 2009 The American Association for Thoracic Surgery

Evolving Technology/Basic Science

Minimally invasive surgical ablation of atrial fibrillation: Six-month results

^a Cardiopulmonary Research Science and Technology Institute, Dallas, Tex
^b Medical City Dallas Hospital, Dallas, Tex
^c St Francis Heart Center, Indianapolis, Ind
^d Washington Adventist Hospital, Tacoma Park, Md
^e Oregon Heart and Vascular Institute, Eugene, Ore
^f University Community Hospital, Tampa, Fla

Received for publication May 14, 2008; revisions received August 22, 2008; accepted for publication September 19, 2008.

^_* Address for reprints: James R. Edgerton, MD, 4708 Alliance Blvd, Suite 700, Plano, Texas 75093. (Email: edgertonjr{at}aol.com).

Background: A minimally invasive surgery for treatment of atrial fibrillation was developed with bilateral pulmonary vein isolation, mapping, and ablation of the ganglionic plexi and excision of the left atrial appendage. A prospective multicenter registry was created to evaluate the outcomes.

Methods: The procedure was performed through bilateral minithoracotomies with video assistance. It included bilateral pulmonary vein isolation with bipolar radiofrequency with documentation of conduction block, location of ganglionic plexi by high-frequency stimulation, and appropriate ablation and left atrial appendage exclusion/excision. Clinical follow-up at 6 months included monitoring with electrocardiogram, Holter, event monitor, or pacemaker interrogation.

Results: One hundred fourteen patients with 60 (52.6%) paroxysmal, 32 (28.1%) persistent, and 22 (19.3%) long-standing persistent atrial fibrillations were treated. The mean age was 59.5 ± 10.6 years, and 69.3% were men. The mean follow-up period was 204 ± 41 days (median 195). There were 2 (1.8%) operative mortalities. At 6-month follow-up, with long-term monitoring, 52/60 (86.7%) patients with paroxysmal fibrillations were in normal sinus rhythm and 43/60 (71.7%) were both in normal sinus rhythm and off antiarrhythmic drugs. The patients with persistent atrial fibrillation had a lower success rate, with 18/32 (56.3%) being in normal sinus rhythm and 46.9% both in normal sinus rhythm and off antiarrhythmic drugs; for long-standing persistent cases, 11/22 (50%) were in normal sinus rhythm and 7/22 (31.9%) were also off antiarrhythmic drugs.

Conclusions: Minimally invasive atrial fibrillation surgery is an effective treatment of paroxysmal atrial fibrillation at 6 months. Continuous event monitoring is necessary to accurately assess treatment results. A more extensive lesion set seems to be required for treatment of persistent atrial fibrillation.

This article has been cited by other articles:

				R. J. Damiano Surgical ablation of lone atrial fibrillation on the beating heart: the chaos continues Europace, February 5, 2010; (2010) eup442v1. [Full Text] [PDF]

				A. C. Kiser and W. Cockfield Paracardioscopic ex-maze procedure for atrial fibrillation MMCTS, February 1, 2010; 2010(0201): 3863. [Abstract] [Full Text] [PDF]