Pulmonary vein isolation and autonomic denervation for the management of paroxysmal atrial fibrillation by a minimally invasive surgical approach
Open accessAbstract
Background Advances in technology such as epicardial bipolar radiofrequency pulmonary vein isolation, ganglionated plexi identification, and isolation and thoracoscopic left atrial appendage exclusion have enabled less invasive surgical options for management of atrial fibrillation.Methods We performed a prospective, nonrandomized study of consecutive patients with symptomatic paroxysmal atrial fibrillation undergoing a video-assisted, minimally invasive surgical ablation procedure. The procedure consisted of bilateral, epicardial pulmonary vein isolation with bipolar radiofrequency, partial autonomic denervation, and selective excision of the left atrial appendage. Minimum follow-up was 1 year with long-term monitoring (24-hour continuous, 14-day event or pacemaker interrogation).Results Between March 2005 and January 2008, 52 patients (35 male), mean age 60.3 years (range, 42-79 years) underwent the procedure. The left atrial appendage was isolated in 88.0% (44/50). Average hospital stay was 5.2 days (range 3-10 days). There were no operative deaths or major adverse cardiac events. On long-term monitoring, freedom from atrial fibrillation/flutter/tachycardia was 86.3% (44/51) and 80.8% (42/52) at 6 and 12 months, respectively. Antiarrhythmic drugs were stopped in 33 of 37 patients and warfarin in 30 of 37 of the patients in whom ablation was successful at 12 months. Freedom from symptoms attributed to atrial fibrillation/flutter/tachycardia was 78.0% (39/50) at 6 months and 63.8% (30/47) at 12 months.Conclusions Minimally invasive surgical ablation is effective in the management of paroxysmal atrial fibrillation as evidenced by freedom from atrial arrythmias by long-term monitoring at 12 months. Measuring success using clinical symptoms underestimated clinical success as compared with long-term monitoring.
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Thoracoscopic pulmonary vein isolation with bipolar radiofrequency prevents recurrence of paroxysmal atrial fibrillation (69-91% freedom from arrhythmias at 1 year).
“Thoracoscopic PVI with bipolar radiofrequency prevents recurrence of paroxysmal AF (69-91% freedom from arrhythmias at 1 year, see Figure 18B for lesion set), 468,809,810”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [809]
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“Whilst freedom from AF reaching 91% has been obtained at 3 and 6 months [52, 53], long-term followup has been less encouraging [22, 36, 54].”
BackgroundBadhwar, N., Tschopp, D. R., & Lee, R. J. (2015) · Current Problems in Cardiology · doi:10.1016/j.cpcardiol.2015.01.005 · Cited by 7 · see citing works
The Convergent Procedure: A Unique Multidisciplinary Hybrid Treatment of Atrial Fibrillation
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Revishvili, A. S., Kadyrova, M., Va, P., Сергеевич, М. Е., Karmazanovsky, G. G., Дмитриевна, С. Е., Shirokov, V. S., Novikov, M. A., Yalova, E. V., & Азатовна, Т. И. (2022) · Medical Visualization · doi:10.24835/1607-0763-1162 · Cited by 5 · see citing works
“Atrial fibrillation (AF) is the most common arrhythmia, the prevalence in the population is on average 0,4–2% [1, 2].”
BackgroundZheng, S., Zeng, Y., Li, Y., Han, J., Zhang, H., & Xu, M. (2014) · Journal of Cardiac Surgery · doi:10.1111/jocs.12299 · Cited by 5 · see citing works
“The one-year success rates in our study are in keeping with prior reports of 65% to 77%.(4,12,16) For paroxysmal AF, long-term single-procedure success is acceptable.”
BackgroundMethodResultAtrial Fibrillation Ablation by the Epicardial Approach.
Gehi, A. K., Kiser, A. C., & Mounsey, J. P. (2014) · Europe PMC (PubMed Central) · doi:10.4022/jafib.979 · Cited by 5 · see citing works
Surgical treatment for atrial fibrillation: where do we stand?
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Surgical Treatment of Atrial Fibrillation
Navaratnarajah, M., Luthra, S., & Ohri, S. K. (2020) · IntechOpen eBooks · doi:10.5772/intechopen.91225 · Cited by 4 · see citing works
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Atrial Fibrillation and the Autonomic Nervous System
Stavrakis, S., & Jackman, W. M. (2012) · Hospital chronicles/Hospital Chronicles · doi:10.2015/hc.v7i3.511 · Cited by 4 · see citing works
Surgical treatment of atrial fibrillation: State of the art, 2012
Nitta, T., Ishii, Y., & Sakamoto, S. (2012) · Journal of Arrhythmia · doi:10.1016/j.joa.2012.07.007 · Cited by 4 · see citing works
“[18] demonstrated that freedom from AF or AT should be assessed by long-term monitoring.”
BackgroundAutonomic denervation for the treatment of atrial fibrillation.
Katritsis, D. G. (2011) · Europe PMC (PubMed Central) · Cited by 4 · see citing works
Surgical Management of Atrial Fibrillation
Bedeir, K., & Ramlawi, B. (2020) · Springer eBooks · doi:10.1007/978-3-030-24174-2_79 · Cited by 3 · see citing works
Johnkoski, J. A., Miles, B., Sudbury, A. J., Osman, M., Munir, M. B., Balla, S., & Benjamin, M. M. (2019) · Journal of Cardiothoracic Surgery · doi:10.1186/s13019-019-1018-4 · Cited by 3 · see citing works
Hybrid Surgical and Catheter Treatment for Atrial Fibrillation
Kaneko, T., & Aranki, S. F. (2013) · ISRN Cardiology · doi:10.1155/2013/920635 · Cited by 3 · see citing works
The Role of Renal Sympathetic Denervation in Atrial Fibrillation.
Kosiuk, J., Pokushalov, E., Hilbert, S., Hindricks, G., Bollmann, A., & Md, J. S. S. (2014) · Europe PMC (PubMed Central) · doi:10.4022/jafib.987 · Cited by 3 · see citing works
Belluschi, I., Lapenna, E., Carino, D., Trumello, C., Cireddu, M., Ruggeri, S., Schiavi, D., Monaco, F., Pozzoli, A., Agricola, E., et al. (2021) · European Journal of Cardio-Thoracic Surgery · doi:10.1093/ejcts/ezab138 · Cited by 3 · see citing works
Surgical Management of Atrial Fibrillation
Yanagawa, B., Khaled, D., & Cohe, G. (2012) · InTech eBooks · doi:10.5772/28442 · Cited by 3 · see citing works
Catheter Versus Surgical Ablation of Atrial Fibrillation: An Analysis of Outcomes
Weiner, M. M., Baron, E. L., Joshi, K., Villablanca, P. A., Briceno, D. F., Torregrossa, G., Evans, A. S., Augoustides, Y., & Ramakrishna, H. (2018) · Journal of Cardiothoracic and Vascular Anesthesia · doi:10.1053/j.jvca.2018.01.015 · Cited by 3 · see citing works
Synopsis of Adult Cardiac Surgical Disease
Bojar, R. M. (2005) · Wiley eBooks · doi:10.1002/9781444318364.ch1 · Cited by 3 · see citing works
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Need for Ongoing Anti Arrhythmic Drugs After Ablation of Atrial Fibrillation. Review
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“[59] Video-assisted, bilateral”
Total endoscopic ablation of atrial fibrillation
Fengsrud, E., Wickbom, A., & Ahlsson, A. (2015) · Multimedia Manual of Cardio-Thoracic Surgery · doi:10.1093/mmcts/mmv010 · Cited by 2 · see citing works
Park, J., & Pak, H. (2015) · PubMed Central · doi:10.4022/jafib.1207 · Cited by 2 · see citing works
Nonpharmacologic Treatment of Tachyarrhythmias
Callans, D. J., & Anter, E. (2012) · Elsevier eBooks · doi:10.1016/b978-1-4557-0101-8.00021-7 · Cited by 3 · see citing works
Surgical options in atrial fibrillation.
Ramlawi, B., & Bedeir, K. (2015) · Europe PMC (PubMed Central) · doi:10.3978/j.issn.2072-1439.2014.12.34 · Cited by 2 · see citing works
“Results from other small studies however seem to be heterogeneous and inconsistent, reporting a 1 year freedom from AF and AAD ranging from 20-88% (40-43).”
ResultPick, A., Kotschet, E., Healy, S., Adam, D. C., & Bittinger, L. (2023) · Heart Lung and Circulation · doi:10.1016/j.hlc.2023.06.002 · Cited by 1 · see citing works
Narrative Review: Surgical and Hybrid Management of Atrial Fibrillation
Trohman, R. G. (2024) · Cardiology and Therapy · doi:10.1007/s40119-024-00377-2 · Cited by 1 · see citing works
“The procedure reported included pulmonary vein isolation with bipolar RF application, intraoperative confirmation of transmurality, mapping for and ablation of gan-glionated plexi (GP), division of the ligament of Marshall and excision or exclusion of the left atrial appendage [47].”
BackgroundMethodInfluentialSurgical Atrial Fibrillation Ablation
Anter, E., & Callans, D. J. (2012) · Cardiac Electrophysiology Clinics · doi:10.1016/j.ccep.2012.06.002 · Cited by 1 · see citing works
Minimally invasive cardiac surgery, port-access and robotic surgery
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The Left Atrial Neural Network: More Complicated Than We thought?
Lim, P. B., & Kanagaratnam, P. (2015) · Future Cardiology · doi:10.2217/fca.15.21 · Cited by 1 · see citing works
Synopsis of Adult Cardiac Surgical Disease
Bojar, R. M. (2020) · Wiley eBooks · doi:10.1002/9781119582540.ch1 · Cited by 1 · see citing works
Hill, A. C., & Guy, T. S. (2012) · Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery · doi:10.1097/imi.0b013e3182551936
“A recent report of patients undergoing minimally invasive surgical ablation for AF found that 12% of the patients in the study did not undergo planned LAA closure because there were LAA features that countermanded use of the GIA stapling device because of concerns regarding anatomic variability and safety.(39) Stroke…”
BackgroundReview Article Autonomic Denervation for the Treatment of Atrial Fibrillation
Katritsis, D. G. (2011)
Chirurgische Therapie des Vorhofflimmerns
Weimar, T. (2015) · Zeitschrift für Herz- Thorax- und Gefäßchirurgie · doi:10.1007/s00398-015-0041-6
“mit einer endoskopischen Pulmonalvenenisolation eine VHF-Freiheit von 86% und 81% nach 12 und 24 Monaten erreichen [20].”
BackgroundSurgery for Atrial Fibrillation and Other SVTs
Robertson, J. O., Saint, L. L., & Damiano, R. J. (2013) · Elsevier eBooks · doi:10.1016/b978-1-4557-2856-5.00128-x
Surgery for Atrial Fibrillation and Other Supraventricular Tachycardias
Schill, M. R., Melby, S. J., Schuessler, R. B., & Damiano, R. J. (2017) · Elsevier eBooks · doi:10.1016/b978-0-323-44733-1.00133-4
Non-medication Treatment of Atrial Fibrillation
Park, J. (2017) · International Journal of Arrhythmia · doi:10.18501/arrhythmia.2017.023
Epicardial and Endocardial Hybrid Ablation for Atrial Fibrillation
Kiser, A. C., & Mounsey, J. P. (2019) · Elsevier eBooks · doi:10.1016/b978-0-323-52992-1.00020-x
Epicardial and Endocardial Hybrid Ablation for Atrial Fibrillation
Kiser, A. C., & Liu, J. (2024) · Elsevier eBooks · doi:10.1016/b978-0-323-93110-6.00021-9
Дмитриевна, С. Е., Artyukhina, Е. А., Kadyrova, M., & Revishvili, A. S. (2025) · Complex Issues of Cardiovascular Diseases · doi:10.17802/2306-1278-2025-14-4-102-122
Calvo, N. (2013) · LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas)
Perspective Chapter: The Evolving Surgical Management of Atrial Fibrillation
Asopa, S., Modi, A., Ali-Ghosh, H., & Ohri, S. K. (2026) · Cardiology and cardiovascular medicine. · doi:10.5772/intechopen.1016107
- Authors
- Edgerton, J. R., Brinkman, W. T., Weaver, T., Prince, S. L., Culica, D., Herbert, M. A., & Mack, M. J.
- Affiliations
- Heart Hospital Baylor Plano (US)
- Medical City Dallas Hospital (US)
- Cardiopulmonary Research Science and Technology Institute (US)
- Corresponding author
- Edgerton, James R.
- Venue
- The Journal of Thoracic and Cardiovascular Surgery
- Publisher
- Elsevier BV
- Published
- 2010-10
- Volume
- 140
- Issue
- 4
- Pages
- 823-828
- ISSN
- 0022-5223 (ISSN-L)
- OpenAlex
- W2017254899
- Cited by
- 99
- References
- 21
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 3 · 2023: 2 · 2022: 2 · 2021: 1 · 2020: 4 · 2019: 6 · 2018: 2 · 2017: 4 · 2016: 11 · 2015: 11 · 2014: 7 · 2013: 14 · 2012: 18
- FWCI
- 9.44
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- 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
- paroxysmal atrial fibrillation, pulmonary vein isolation, autonomic denervation, minimally invasive cardiac surgery, video-assisted thoracoscopic surgery, bipolar radiofrequency ablation, left atrial appendage excision, antiarrhythmic drug discontinuation, warfarin discontinuation
- MeSH terms
- Adult, Aged, Atrial Fibrillation, Feasibility Studies, Female, Humans, Length of Stay, Male, Middle Aged, Prospective Studies, Pulmonary Veins, Texas, Time Factors, Treatment Outcome, Catheter Ablation, Autonomic Denervation, Atrial Appendage, Thoracic Surgery, Video-Assisted, Secondary Prevention
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