Thoracoscopic pulmonary vein isolation in patients with atrial fibrillation and failed percutaneous ablation
Open accessAbstract
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 Antiarrhythmic therapy was withdrawn 3 months postoperatively.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.
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Thoracoscopic pulmonary vein isolation with bipolar radiofrequency seems effective in patients refractory to catheter ablation.
“and seems effective in patients refractory to catheter ablation.811”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [811]
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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
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- Authors
- Castellá, M., Pereda, D., Mestres, C. A., Gómez, F., Quintana, E., & Mulet, J.
- Affiliations
- Hospital Clínic de Barcelona (ES)
- Venue
- The Journal of Thoracic and Cardiovascular Surgery
- Publisher
- Elsevier BV
- Published
- 2010-09
- Volume
- 140
- Issue
- 3
- Pages
- 633-638
- ISSN
- 0022-5223 (ISSN-L)
- OpenAlex
- W2001564316
- Cited by
- 29
- References
- 13
- Citations by year
- 2026: 1 · 2024: 1 · 2022: 2 · 2021: 2 · 2020: 1 · 2018: 1 · 2016: 5 · 2015: 6 · 2012: 4
- FWCI
- 1.98
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of Thoracic and Cardiovascular Surgery (publishedVersion)
- PubMed (publishedVersion)
- Funders
- AtriCure
- 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, failed catheter ablation, radiofrequency ablation, bipolar radiofrequency, paroxysmal atrial fibrillation, persistent atrial fibrillation, long-standing persistent atrial fibrillation, sinus rhythm maintenance, left atrial size, minimally invasive cardiac surgery
- MeSH terms
- Adult, Aged, Atrial Fibrillation, Female, Humans, Male, Middle Aged, Pulmonary Veins, Risk Factors, Spain, Thoracotomy, Time Factors, Logistic Models, Catheter Ablation, Treatment Failure, Risk Assessment, Thoracic Surgery, Video-Assisted
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