Thoracoscopic Ablation for Persistent and Long Persistent Atrial Fibrillation 3 Years Follow-up

Konstantin A. Smolianinov, Sergey A. Stefanov, Pavel A. Durygin, Jury V. Zapriagaev, Zhargalma B. Dandarova, Denis Y. Nikitin

Regional clinical hospital, Khanty-Mansiysk, Russia

Date, time and location: 2018.05.26 08:30, Congress Hall, 2F–A

Abstract

Objective Among patients with persistent and long-persistent atrial fibrillation (AF) on the background of a pronounced dilatation of left atrium (LA), catheter endocardial radio frequency ablation (RFA) have a low efficacy. The aim of the study is to evaluate the long-term results of epicardial thoracoscopic RFA in patients with persistent and long-persistent AF.

Methods From Nov 2014 till Nov 2017, 60 transthoracic RFA procedures were performed, supplemented with  removal of  LA appendage. The average age was 60.3 (from 43 to 73), 81% male. Neurological complications previously transferred in 7 (11.7%) cases, catheter interventions in 20 (33%). The duration of arrhythmia was 64.5 months. (from 4 till 180), duration of non-restoration the rhythm was 14.7 months (from 2 till 60), volume LA was 92.7 ± 27.1 ml. Procedure was performed with bilateral access with single-lung ventilation. After discharge patients were prescribed oral anticoagulants and anti-arrhythmic drugs for 3 months.

Results  Freedom from AF at discharge was 57 (95%). In 3 (5%) cases implantation of pacemaker was required. The duration of follow-up was 2 to 36 months, median 15.7, 882 patient-months. Freedom from the AF in follow-up group was 88.3%. In 5 patients were registered atypical atrial flutter. The cause was the gap in ablation lines, which were successfully succeeded by point endocardial interventions. The most frequent gap was registered on LA roof, in the area from the upper left PV to base of LA appendage (4). In two cases were mapped several breakthrough sites. Where were no strokes and fatal cases in long-term period.

Conclusions Thoracoscopic epicardial RFA provides encouraging long-term results for management in right rhythm control in patients with persistent forms of AF and dilated LA. The most precise impact during the procedure requires an area between the upper left PV and the appendage of LA.