Stand Alone Totally Endoscopic Epimyocardial Ablation in Patients with Persistent Atrial Fibrillation and Significant Atrial Dilatation

BackgroundTo analyze safety and efficacy of surgical totally endoscopic epimyocardial ablation in patients (pts) turned down for interventional catheter therapy due to long-standing persistent atrial fibrillation (pAF) combined with significant atrial dilatation (>5cm). MethodsSince December 2010, 15 pts were referred for surgical ablation due to persistent AF combined with biatrial dilatation (left atrium [LA] 5.00.6cm). Mean age was 526 years, body mass index (BMI) 38 +/- 6, duration of AF 2.8 +/- 1.2 years, left ventricular end diastolic diameter (LVEDD) 5.8cm +/- 0.6cm. Ablation was performed via a bilateral endoscopic approach using bipolar RF energy application. Monitoring was achieved by an event recorder (Reveal XT Medtronic, Inc., Minneapolis, MN, USA) or repeated 24-hours Holter electrocardiogram. ResultsAll pts successfully received bilateral pulmonary vein isolation+box lesion+trigonal lesion+left atrial appendage resection. Mean duration of procedure was 235 +/- 70minutes. There was no intraoperative complication; however, one patient had persistent left phrenic nerve palsy. Mean hospital stay was 4 +/- 2 days, mean follow-up time was 21 +/- 11 months. Incidence of sinus rhythm (SR) was 67, 73, and 80% at discharge, three months, and 12 months follow-up. Mean LA diameter was reduced from 58.1mm +/- 6.0mm preoperative to 49.7mm +/- 5.4mm (p=0.004) at 12 months follow-up. Incidence of SR was 86% at latest follow-up (mean time 21 months). All pts currently in SR (13/15=86%) are of class I or III antiarrhythmic drugs. ConclusionTotally endoscopic left atrial ablation including left atrial resection can safely be performed. It achieved excellent rates of SR restoration in patients with long-standing persistent AF combined with significant atrial dilatation. doi: 10.1111/jocs.12523 (J Card Surg 2015;30:469-473)