Thoracoscopic pulmonary vein isolation in patients with atrial fibrillation and failed percutaneous ablation

Objective Pulmonary vein isolation is indicated in patients with symptomatic isolated atrial fibrillation not controlled with antiarrhythmic therapy. We describe our surgical experience with thoracoscopic pulmonary vein isolation in patients in whom percutaneous ablation has failed. Methods Thirty-f...

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Bibliographic Details
Published in:The Journal of thoracic and cardiovascular surgery 2010-09, Vol.140 (3), p.633-638
Main Authors: Castellá, Manuel, MD, PhD, Pereda, Daniel, MD, Mestres, Carlos A., MD, PhD, FETCS, Gómez, Félix, MD, Quintana, Eduard, MD, Mulet, Jaume, MD, PhD
Format: Article
Language:English
Subjects:
Adult
Aged
Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy
Atrial Fibrillation - physiopathology
Atrial Fibrillation - surgery
Biological and medical sciences
Cardiac dysrhythmias
Cardiology. Vascular system
Cardiothoracic Surgery
Catheter Ablation - adverse effects
Female
Heart
Humans
Logistic Models
Male
Medical sciences
Middle Aged
Pneumology
Pulmonary Veins - physiopathology
Pulmonary Veins - surgery
Risk Assessment
Risk Factors
Spain
Thoracic Surgery, Video-Assisted - adverse effects
Thoracotomy
Time Factors
Treatment Failure
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Summary:Objective Pulmonary vein isolation is indicated in patients with symptomatic isolated atrial fibrillation not controlled with antiarrhythmic therapy. We describe our surgical experience with thoracoscopic pulmonary vein isolation in patients in whom percutaneous ablation has failed. Methods Thirty-four adult patients with unsuccessful catheter ablations (range 1–4, mean 2 ± 1) underwent thoracoscopic bipolar-radiofrequency pulmonary vein isolation. Seventeen patients had paroxysmal atrial fibrillation, 12 with persistent and 5 with long-standing persistent fibrillation, for a mean of 6 years (range 3–10 years), 13 years (5–25 years), and 9 years (3–15 years), respectively. Results There was no mortality during the procedure or follow-up (mean 16 ± 11 months). Two patients needed conversion to thoracotomy owing to hemorrhage, and ablation could not be completed. Antiarrhythmic therapy was withdrawn 3 months postoperatively. Postoperative sinus rhythm was maintained in 82% of those with paroxysmal atrial fibrillation (13/15 at 6 months, 9/11 at 12 months), 60% had persistent atrial fibrillation (8/12 at 6 months and 6/10 at 12 months), and 20% had long-standing persistent atrial fibrillation (1/5 at 6 and 12 months). Preoperative left atrial diameter significantly differed between patients with paroxysmal fibrillation (mean 42 ± 6 mm) and those with persistent and long-standing persistent fibrillation (means 50 ± 4 and 47 ± 2 mm). Left atrial size greater than 45 mm and atrial fibrillation type were preoperative factors that significantly influenced outcome in the univariate logistic regression analysis. Conclusions Thoracoscopic pulmonary vein isolation in patients with previously unsuccessful catheter ablations demonstrates satisfactory sinus rhythm maintenance rates in paroxysmal and persistent atrial fibrillation, but not in long-standing persistent atrial fibrillation. As with other minimally invasive surgical techniques, there is an important learning curve.
ISSN:0022-5223
1097-685X
DOI:10.1016/j.jtcvs.2009.11.009