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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.

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