Cor Vasa 2017, 59(4):e317-e324 | DOI: 10.1016/j.crvasa.2017.06.004

Thoracoscopic ablation of atrial fibrillation - Should we still be concerned about periprocedural complications?

Petr Budera^*, Pavel Osmančík, David Talavera, Anna Kraupnerová, Vitalii Rizov, Richard Fojt, Zbyněk Straka

Kardiocentrum, 3. lékařská fakulta Univerzity Karlovy a Fakultní nemocnice Královské Vinohrady, Praha, Česká republika

Introduction: Minimally invasive surgical ablations are becoming an interesting treatment option for patients with stand-alone atrial fibrillation (AF). However, they are in general connected with higher rates of perioperative complications. The aim of this study was to summarize the complications of all such procedures performed in our center and compare them with similar recent papers.

Material and methods: All perioperative and 30-day complications of thoracoscopic ablations of AF performed in our center were collected and analyzed. Recent literature was searched for studies describing the outcomes of thoracoscopic and hybrid ablations. Rates of complications were then compared with our outcomes and also with catheter ablations.

Results: A total of 112 patients underwent a thoracoscopic ablation of AF in our center between 2006 and 2017, with use of three different devices. Mean age was 61.4 ± 8.8 years, 66% were males and 53% of patients had long-standing persistent AF. Life-threatening complications occurred in two (1.8%) patients, including one conversion to sternotomy and one stroke. Severe complications occurred in six (5.4%) patients including two re-explorations for bleeding, three cases of phrenic nerve palsy and one respiratory failure. Minor or moderate complications occurred in 17 (15.2%) patients. Twenty-seven suitable papers were identified in recent literature for comparison (total of 1 869 patients). The rates of significant complications varied between 0 and 16% over different centers, mean rate was 4.8%. Regarding the catheter ablation studies, 5-7% of patients suffer from some severe complication after ablation of AF.

Conclusions: Rates of 30-day, life-threatening and severe complications are comparable between mini-invasive surgical and catheter ablations of AF. Rates of minor complications appear to be higher in surgical ablations. To keep the rates low or even to decrease them, those surgical or hybrid procedures should be performed in experienced centers.

Keywords: Atrial fibrillation; Complications; Hybrid ablation; Outcomes; Surgical ablation

Received: May 27, 2017; Revised: June 7, 2017; Accepted: June 8, 2017; Published: August 1, 2017  Show citation