Thoracoscopic Video-Assisted Pulmonary Vein Antrum Isolation, Ganglionated Plexus Ablation, and Periprocedural Confirmation of Ablation Lesions: First Results of a Hybrid Surgical-Electrophysiological Approach for Atrial Fibrillation
Abstract
BACKGROUND: Thoracoscopic pulmonary vein isolation (PVI) and ganglionated plexus ablation is a novel approach in the treatment of atrial fibrillation (AF). We hypothesize that meticulous electrophysiological confirmation of PVI results in fewer recurrences of AF during follow-up. METHODS AND RESULTS: Surgery was performed through 3 ports bilaterally. Ganglionated plexi were localized and subsequently ablated. PVI was performed and entry and exit block was confirmed. Additional left atrial ablation lines were created and conduction block verified in patients with nonparoxysmal AF. The left atrial appendage was removed. Freedom of AF was assessed by ECGs and Holter monitoring every 3 months or during symptoms of arrhythmia. Antiarrhythmic drugs were discontinued after 3 months and oral anticoagulants were discontinued according to the guidelines. Thirty-one patients were treated (16 paroxysmal AF, 13 persistent AF, 2 long-standing persistent AF). Thirteen patients with nonparoxysmal received additional left atrial ablation lines. After 1 year, 19 of 22 patients (86%) had no recurrences of AF, atrial flutter, or atrial tachycardia and were not using antiarrhythmic drugs (11/12 paroxysmal, 7/9 persistent, and 1/1 long-standing persistent). Three patients had a sternotomy because of uncontrolled bleeding during thoracoscopic surgery. Four adverse events were 1 hemothorax, 1 pneumothorax, and 2 pneumonia. No thromboembolic complications or mortality occurred. CONCLUSIONS: Thoracoscopic surgery with PVI and ganglionated plexus ablation for AF is a safe and successful procedure with a single procedure success rate of 86% at 1 year. Electrophysiological guided thorough PVI and additional left atrial ablation line creation presumably contributes in achieving a high success rate in the surgical treatment of AF.
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Preliminary experience with hybrid simultaneous ablation shows promise, but procedural time and rates of bleeding complications are higher.
“Although preliminary experience with hybrid simultaneous ablation shows promise, procedural time and rates of bleeding complications are higher.812, 823”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [812]
The average length of hospital stay for thoracoscopic ablation varies from 3.6 to 6.0 days.
“The average length of hospital stay for thoracoscopic ablation varies from 3.6 to 6.0 days.468,812,813”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [812]
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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
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- Authors
- Krul, S. P. J., Driessen, A. H. G., van Boven, W. J., Linnenbank, A. C., Geuzebroek, G. S. C., Jackman, W. M., Wilde, A. A. M., de Bakker, J. M. T., & de Groot, J. R.
- Affiliations
- Amsterdam UMC Location University of Amsterdam (NL)
- From the Heart Failure Research Center, Department of Cardiology and Experimental Cardiology, Academic Medical Center, Amsterdam, The Netherlands (S.P.J.K., A.C.L., G.S.C.G., W.M.J., A.A.M.W., J.M.T.d.B., J.R.d.G.); the Department of Cardiothoracic Surgery, Amsterdam Medical Center, Amsterdam, The Netherlands (A.H.G.D.); the Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, The Netherlands (W.J.v.B., G.S.C.G.); the Department of Cardiology, University of Oklahoma Health Science...
- ORCID
- Venue
- Circulation Arrhythmia and Electrophysiology
- Published
- 2011-06
- Volume
- 4
- Issue
- 3
- Pages
- 262-270
- ISSN
- 1941-3084 (ISSN-L)
- 1941-3149
- OpenAlex
- W2549042184
- Cited by
- 194
- References
- 25
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 6 · 2023: 5 · 2022: 7 · 2021: 9 · 2020: 11 · 2019: 10 · 2018: 10 · 2017: 11 · 2016: 18 · 2015: 21 · 2014: 11 · 2013: 22 · 2012: 36
- FWCI
- 16.88
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Circulation Arrhythmia and Electrophysiology (publishedVersion)
- PubMed (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- 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
- thoracoscopic surgery, pulmonary vein isolation, ganglionated plexus ablation, atrial fibrillation, video-assisted surgery, atrial flutter, atrial tachycardia, antiarrhythmic drug discontinuation, procedural safety
- MeSH terms
- Adult, Aged, Atrial Fibrillation, Female, Follow-Up Studies, Ganglia, Autonomic, Humans, Male, Middle Aged, Pulmonary Veins, Retrospective Studies, Thoracoscopy, Electrocardiography, Ambulatory, Treatment Outcome, Catheter Ablation, Autonomic Denervation, Atrial Appendage, Electrophysiological Phenomena
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