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Emin Gurbanov
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Right arrow Minimally invasive surgery

J Thorac Cardiovasc Surg 2010;139:326-332
© 2010 The American Association for Thoracic Surgery

Acquired Cardiovascular Disease

Video-assisted minimally invasive surgery for lone atrial fibrillation: A clinical report of 81 cases

Yong-qiang Cui, MD, PhD, Yan Li, MD, Feng Gao, MD, PhD, Chun-lei Xu, MD, Jie Han, MD, Wen Zeng, MD, Ya-ping Zeng, PhD, Emin Gurbanov, PhD, Xu Meng, MD*

Atrial fibrillation Center, Anzhen Hospital, Beijing, China

Received for publication February 26, 2008; revisions received February 27, 2009; accepted for publication April 28, 2009.

* Address for reprints: Xu Meng, MD, Department of Cardiac Surgery, Beijing Anzhen Hospital, Beijing (100029), P.R. China. (Email: mxu{at}263.net).

Objective: We sought to evaluate the feasibility and efficacy of a new type of video-assisted minimally invasive surgery for patients with atrial fibrillation.

Methods: Between December 2006 and February 2008, 81 patients with lone atrial fibrillation (49 with paroxysmal, 17 with persistent, and 15 with long-standing persistent atrial fibrillation) underwent this therapy with a bipolar radiofrequency ablation system. The main surgical procedures included bilateral pulmonary vein antrum isolation, obliteration of the left atrial appendage, division of the ligament of Marshall, and intraoperative electrophysiologic testing.

Results: The mean operation duration was 2.5 hours. One (1.2%) case was confirmed of left atrial appendage thrombus during the procedure. One (1.2%) patient was converted to sternotomy during the operation. Reintubation occurred in 1 (1.2%) patient, and acute heart failure occurred in 1 (1.2%) patient. One (1.2%) patient died of cerebral infarction 1 month after the operation. Follow-up was done between 3 and 19 months (mean, 12.7 ± 3.9 months) after the operation. At discharge, 72.5% (58/81) of all patients were in sinus rhythm (paroxysmal atrial fibrillation, 83.7%; persistent atrial fibrillation, 64.7%; and long-standing persistent atrial fibrillation, 40.0%). At 3 months, overall 78.5% (62/79) were in sinus rhythm (paroxysmal atrial fibrillation, 85.7%; persistent atrial fibrillation, 82.4%; and long-standing persistent atrial fibrillation, 46.2%). At 6 months, overall 78.5% (62/79) were in sinus rhythm (paroxysmal atrial fibrillation, 85.7%; persistent atrial fibrillation, 70.6%; and long-standing persistent atrial fibrillation, 61.5%). At 12 months, overall 79.6% (39/49) were in sinus rhythm (paroxysmal atrial fibrillation, 80.0%; persistent atrial fibrillation, 75.0%; and long-standing persistent atrial fibrillation, 66.7%). At 18 months, 88.9% (8/9) of the paroxysmal group were in sinus rhythm.

Conclusions: This minimally invasive technique proves to be safe and less traumatic and presents optimistic early outcomes for patients with paroxysmal and persistent atrial fibrillation. It might find wider application if more ablation lesions could be enrolled for long-standing persistent atrial fibrillation.

Abbreviations and Acronyms AF = atrial fibrillation; ECG = electrocardiography; GP = ganglionic plexi; ICS = intercostal space; IVC = inferior vena cava; LAA = left atrial appendage; PV = pulmonary vein; RF = radiofrequency; RSPV = right superior pulmonary vein; SR = sinus rhythm; SVC = superior vena cava; TEE = transesophageal echocardiography; UCG = ultrasonic cardiography




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