Minimally Invasive Surgical Ablation Combined with Postoperative Electrophysiological Evaluation and Intervention Is Highly Effective in the Treatment of Intermittent and Long-Standing Atrial Fibrillation

Background: After interventional therapy for atrial fibrillation, symptomatic recurrences are relatively frequent. Following demonstration flawless interventional pulmonary vein ablation, patients underwent surgical via a video-assisted, subxiphoidal approach. We report here on a single-center experience in 20 patients suffering from intermittent or persistent atrial fibrillation who had undergone multiple unsuccessful interventional ablation procedures.

Method: Twenty patients (14 males, 6 females, mean age: 62.4 ± 2.1 years) suffering from atrial fibrillation (7 paroxysmal, 13 persistent) underwent video-assisted, minimally invasive radiofrequency ablation of the left atrial posterior wall using a newly developed proprietary device via a subxiphoidal approach. All patients had previously undergone an average of 3.0 interventional procedures to treat their intermittent or long-standing atrial fibrillation. An average of 27 (median: 21–33) lesions were created per patient, covering ~85% of the posterior wall area. 17 of 20 patients (85% follow-up) were then again re-examined after an average of 92 days (mean: 82–104) following surgical ablation and underwent electrophysiological examination for possible gaps, which were subsequently re-ablated in the same session. Patients were also queried with respect to current rhythm, episodic atrial fibrillation and the need for electrocardioversion.

Results: Average operation time was 104 minutes (median: 88–125 minutes). No procedural complications occurred. 65% of patients entered the operating room in sinus rhythm, 100% left the operating room in sinus rhythm. Average length of stay was 6 days, and 19 (95%) patients were discharged in sinus rhythm. Seventeen patients (85%) had reached 90-day follow-up. Thirteen patients (76.5%) presented with sinus rhythm without having required any interim intervention. Four patients (23.5%) presented with atrial fibrillation. In the period between index procedure and 90-day follow-up, five patients were readmitted to hospital; one patient was for pericarditis, one patient for minor wound dehiscence, one patient for atrial fibrillation, and two patients for unrelated ailments. On electrophysiological examination, gaps or hot spots could be demonstrated in 15 patients (75%). A total of six patients have subsequently required electrocardioversion for atrial fibrillation, five of which are known to be in sinus rhythm. One patient has died of unrelated causes. Of the total 19 remaining patients who received surgical ablation treatment, 13 patients (68.4%) are currently in stable sinus rhythm.

Conclusion: Minimally invasive, stand-alone surgical ablation combined with postoperative electrophysiological examination and, when necessary, interventional reablation can be safely performed with a high success rate compared with purely interventional treatment.

Publication History

Article published online:
03 February 2022