Video-assisted bilateral pulmonary vein isolation and left atrial appendage exclusion for atrial fibrillation

Wolf, Randall K.; Schneeberger, E. William; Osterday, Robert; Miller, Doug; Merrill, Walter; Flege, John B.; Gillinov, A. Marc

doi:10.1016/j.jtcvs.2005.03.041

Cited by 392Atrial Fibrillation Management and OutcomesCardiac Arrhythmias and TreatmentsCardiac pacing and defibrillation studies

Video-assisted bilateral pulmonary vein isolation and left atrial appendage exclusion for atrial fibrillation

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Wolf, Randall K., Schneeberger, E. William, Osterday, Robert, Miller, Doug, Merrill, Walter, Flege, John B., Gillinov, A. Marc·2005·The Journal of Thoracic and Cardiovascular Surgery

DOI 10.1016/j.jtcvs.2005.03.041

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Abstract

Objective Pulmonary vein isolation is curative in selected patients with atrial fibrillation. The objective of this study was to assess the feasibility and safety (midterm results) of video-assisted thoracoscopic epicardial pulmonary vein isolation.Methods Twenty-seven patients (22 male patients) with atrial fibrillation (18 paroxysmal, 4 persistent, and 5 permanent; average age, 57 years) underwent bilateral video-assisted thoracoscopic off-pump epicardial pulmonary vein isolation and exclusion of the left atrial appendage. All patients had had unsuccessful drug therapy or were intolerant to antiarrhythmic drug therapy or were intolerant to warfarin. The approach included two 10-mm ports and one 5-cm working port (non-rib spreading) bilaterally. Pulmonary vein isolation was achieved bilaterally by using a bipolar radiofrequency device. The left atrial appendage was excised with a surgical stapler.Results Bilateral pulmonary vein isolation and left atrial appendage excision was performed successfully in all patients. There were no conversions to sternotomy or thoracotomy. All patients were extubated in the operating room. Postoperative complications in 3 patients were minor and resolved within 48 hours. One morbidly obese patient had more serious complications related to comorbid conditions. Average postoperative follow-up is approximately 6 months (173.6 days). Twenty-three patients have been followed up for greater than 3 months, and 21 of these patients are free of atrial fibrillation (91.3%). The results of magnetic resonance angiography were normal (no pulmonary vein stenosis) in 12 of 12 patients evaluated 3 to 6 months postoperatively.Conclusions Bilateral video-assisted thoracoscopic pulmonary vein isolation with excision of the left atrial appendage is feasible and safe and offers a promising, new, minimally invasive, beating-heart approach for curative surgical treatment of atrial fibrillation.

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Minimally invasive epicardial ablation surgery for the treatment of stand-alone AF was reported a decade ago.
“Minimally invasive epicardial ablation surgery for the treatment of stand-alone AF was reported a decade ago.1035”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [1035]

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Oral H, Scharf C, Chugh A, et al. Catheter ablation for paroxysmal atrial fibrillation: segmental pulmonary vein ostial ablation versus left atrial ablation. Circulation. 2003;108:2355-60.

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Authors: Wolf, R. K., Schneeberger, E. W., Osterday, R., Miller, D., Merrill, W., Flege, J. B., & Gillinov, A. M.
Affiliations: University of Cincinnati (US)
Cleveland Clinic (US)
Corresponding author: Wolf, Randall K.
ORCID: Merrill, Walter
Gillinov, A. Marc
Venue: The Journal of Thoracic and Cardiovascular Surgery
Publisher: Elsevier BV
Published: 2005-09
Volume: 130
Issue: 3
Pages: 797-802
ISSN: 0022-5223 (ISSN-L)
DOI: 10.1016/j.jtcvs.2005.03.041
OpenAlex: W2006201567
Cited by: 392
References: 34
Citations by year: 2026: 3 · 2025: 8 · 2024: 14 · 2023: 14 · 2022: 5 · 2021: 15 · 2020: 13 · 2019: 12 · 2018: 17 · 2017: 24 · 2016: 17 · 2015: 23 · 2014: 18 · 2013: 32 · 2012: 34
FWCI: 13.98
Type: journal article
Language: en
Update notices: erratum (2006-04-01)
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 3961 d)
Locations: Journal of Thoracic and Cardiovascular 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: atrial fibrillation, pulmonary vein isolation, left atrial appendage exclusion, video-assisted thoracoscopic surgery, epicardial approach, off-pump surgery, bipolar radiofrequency ablation, minimally invasive cardiac surgery, surgical outcomes, pulmonary vein stenosis
MeSH terms: Adult, Aged, Atrial Fibrillation, Female, Cardiac Surgical Procedures, Humans, Male, Middle Aged, Postoperative Complications, Pulmonary Veins, Catheter Ablation, Atrial Appendage, Thoracic Surgery, Video-Assisted

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Video-assisted bilateral pulmonary vein isolation and left atrial appendage exclusion for atrial fibrillation

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