Approaching a paradigm shift: endoscopic ablation of lone atrial fibrillation on the beating heart
Open accessAbstract
Background Percutaneous catheter ablation has been the preferred treatment strategy for many patients with symptomatic drug-refractory atrial fibrillation (AF). However, incomplete ablation lines and varying success rates remain a problem in certain subgroups. This article evaluates the feasibility and efficacy of endoscopically performed left atrial ablation in patients with lone AF.Methods Epicardial bipolar radiofrequency ablation was performed on the beating heart through a bilateral endoscopic approach in 89 consecutive patients with lone AF. This included isolation of the pulmonary veins using a clamp; isolation of the posterior left atrial wall, including a trigonal line to the aortic noncoronary sinus using a linear ablation device; and resection of the left atrial appendage (LAA). Preoperative, perioperative, and postoperative data were collected prospectively and included questionnaires and 24-hour Holter monitoring at 6 and 12 months and annually thereafter.Results Mean follow-up was 12±6 months (range, 4-28 months). No patients were lost to follow-up. Mean duration of AF was 6.4±5.7 years, with 35% paroxysmal AF and 65% persistent or long-standing persistent AF. Mean operation time was 180±43 minutes. There were no deaths, no conversion to sternotomy, and no early or late stroke. Freedom from AF was 88%, 90%, and 90% at 6, 12, and 24 months, respectively. Freedom from AF without antiarrhythmic drugs was 71%, 82%, and 90% at 6, 12, and 24 months, respectively.Conclusions Endoscopic radiofrequency ablation on the beating heart reveals high success rates with low procedure-related morbidity. For improvement of future treatment strategies, a randomized trial is advisable to compare this procedure with catheter ablation in certain patient subgroups.
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The procedure for stand-alone AF has since evolved towards a totally thoracoscopic procedure, and lesion sets were extended to a complete left atrial maze.
“The procedure has since evolved towards a totally thoracoscopic procedure, 1036 and lesion sets were extended to a complete left atrial maze.822”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [822]
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- Weimar T, Schena S, Bailey MS, et al. The Cox-Maze procedure for lone atrial fibrillation: a single-center experi- ence over 2 decades. Circ Arrhythm Electrophysiol 2012;5: 8 -14.
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- Authors
- Weimar, T., Vosseler, M., Czesla, M., Boscheinen, M., Hemmer, W. B., & Doll, K.-N.
- Corresponding author
- Weimar, Timo
- Venue
- The Annals of Thoracic Surgery
- Publisher
- Elsevier BV
- Published
- 2012-12
- Volume
- 94
- Issue
- 6
- Pages
- 1886-1892
- ISSN
- 0003-4975 (ISSN-L)
- OpenAlex
- W1977303078
- Cited by
- 46
- References
- 33
- Citations by year
- 2025: 1 · 2024: 1 · 2023: 2 · 2021: 1 · 2020: 2 · 2019: 2 · 2018: 3 · 2017: 7 · 2016: 7 · 2015: 8 · 2014: 2 · 2013: 8 · 2012: 2
- FWCI
- 4.12
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Annals of Thoracic Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac pacing and defibrillation studies
- Keywords
- lone atrial fibrillation, endoscopic radiofrequency ablation, left atrial appendage resection, pulmonary vein isolation, drug-refractory atrial fibrillation
- MeSH terms
- Atrial Fibrillation, Endoscopy, Feasibility Studies, Female, Follow-Up Studies, Heart Conduction System, Humans, Male, Middle Aged, Pulmonary Veins, Retrospective Studies, Electrocardiography, Ambulatory, Treatment Outcome, Catheter Ablation
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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