Cor Vasa 2017, 59(4):e332-e336 | DOI: 10.1016/j.crvasa.2017.05.009

Thoracoscopic radiofrequency ablation for lone atrial fibrillation: Box-lesion technique

Aleš Klváček^a,*, Andrea Steriovský^a, Jakub Konečný^a, Tomáš Skála^b, Vladimír Lonský^a, Petr Šantavý^a

^a Kardiochirurgická klinika, Lékařská fakulta Univerzity Palackého a Fakultní nemocnice Olomouc, Olomouc, Česká republika

^b I. interní klinika - kardiologická, Lékařská fakulta Univerzity Palackého a Fakultní nemocnice Olomouc, Olomouc, Česká republika

Background: We report the feasibility and outcomes of box-lesion ablation technique to treat stand-alone atrial fibrillation (AF).

Methods: There were 31 patients with a mean age of 63.3 ± 8.4 years who underwent bilateral totally thoracoscopic ablation of symptomatic paroxysmal AF (n = 8; 25.8%) and long-standing persistent AF (n = 23; 75.2%). The box-lesion procedure included bilateral pulmonary vein and left atrial posterior wall ablation using irrigated bipolar radiofrequency with documentation of conduction block.

Results: There were no intra- or perioperative ablation-related complications. There was no operative mortality, no myocardial infarction, and no stroke. Skin-to-skin procedure time was 152.1 ± 36.7 min and the postoperative average length of stay was 6.26 ± 1.24 days. At discharge, 29 patients (93.5%) were in sinus rhythm. Median follow-up time was 20.4 ± 8.3 months. At three months postsurgery, 20 patients of 30 (66.6%) were free from AF without the need of antiarrhythmic drugs. Six patients (20%) underwent catheter reablation. Twenty-three patients (76.6%) were in sinus rhythm at one year after the last performed ablation (surgical ablation or catheter reablation).

Conclusion: The thoracoscopic box-lesion ablation procedure is a safe, effective, and minimally invasive method for the treatment of isolated (lone) AF. This procedure provided excellent short-term freedom from AF.

Keywords: Atrial fibrillation; Box-lesion; Thoracoscopy

Received: January 13, 2017; Revised: May 16, 2017; Accepted: May 17, 2017; Published: August 1, 2017  Show citation