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Thorac Cardiovasc Surg
DOI: 10.1055/a-2625-9617
Original Cardiovascular

Totally Thoracoscopic Ablation for Atrial Fibrillation: All-Box Clamping

A Study from the German Cardiosurgical Atrial Fibrillation Registry
Nicolas Doll
1   Department of Cardiac Surgery, Integrated Heart Center, Schuechtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Germany
,
Antonia Doll
2   Faculty of Medicine, Georg-August-Universität Göttingen, Göttingen, Germany
,
Geza Horvath
1   Department of Cardiac Surgery, Integrated Heart Center, Schuechtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Germany
,
Gerold Mönnig
3   Department of Cardiology, Integrated Heart Center, Schuechtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Germany
,
Christian Pott
3   Department of Cardiology, Integrated Heart Center, Schuechtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Germany
,
Thorsten Hanke
4   Department of Cardiac Surgery, Asklepios Klinikum Hamburg, Hamburg, Germany
,
Taoufik Ouarrak
5   Stiftung Institute für Herzinfarktforschung, Ludwigshafen am Rhein, Germany
,
Jochen Senges
5   Stiftung Institute für Herzinfarktforschung, Ludwigshafen am Rhein, Germany
,
Mahmoud Wehbe 
1   Department of Cardiac Surgery, Integrated Heart Center, Schuechtermann-Klinik Bad Rothenfelde, Bad Rothenfelde, Germany
› Author Affiliations
Funding The CASE-AF registry has been supported by a grant from Atricure Europe BV, De Entree 260, 1101 EE Amsterdam Z. O. This work itself received no additional funding.
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Abstract

Background

Epicardial surgical ablation is an effective strategy to treat non-paroxysmal forms of atrial fibrillation. Current thoracoscopic epicardial surgical strategies are complex, and are therefore often avoided. With slight modifications to the thoracoscopic maze procedure, totally thoracoscopic all-box clamping may facilitate the performance of epicardial thoracoscopic ablation, while maintaining good results.

Methods

Between December 2023 and December 2024, 42 patients underwent thoracoscopic all-box clamping at a single center. All-box clamping uses commercially available bipolar radiofrequency clamps for isolation of the ipsilateral pulmonary veins and posterior left atrial wall through right and then left-sided thoracoscopic access. The left atrial appendage is occluded using a clip device, and the ligament of Marshall is transected. Assessment of a bidirectional block confirmed electrical isolation. Data from the CASE-AF registry were analyzed retrospectively. Short-term results pertaining to efficacy and safety are provided.

Results

All-box clamping was successfully offered to all patients by three surgeons. There were no reported major or minor complications. The median hospital stay was 6 days (interquartile range 5–6). At discharge, a sinus rhythm was observed in 92.9%, and in 76.1% of patients off any class I/III antiarrhythmic drugs.

Conclusion

Surgical ablation with a modified thoracoscopic technique is safe and feasible for the treatment of atrial fibrillation.

Keywords

arrhythmia surgery - minimally invasive surgery - cardiac catheterization

Authors' Contribution

Study design: N.D., G.M., C.P., T.H., J.S., and M.W.; Data acquisition: N.D., A.D., G.H., G.M., C.P., T.H., T.O., and M.W.; data analysis and interpretation: A.D., G.H., T.O., J.S., and M.W.; manuscript drafting: A.D., G.H., J.S., and M.W.; statistical analysis: T.O. and M.W.; critical revision: N.D., G.M., C.P., J.S., and T.H.; accountability: N.D., A.D., G.H., G.M., C.P., T.H., T.O., J.S., and M.W.




Publication History

Received: 29 March 2025

Accepted: 01 June 2025

Accepted Manuscript online:
03 June 2025

Article published online:
27 June 2025

© 2025. Thieme. All rights reserved.

Georg Thieme Verlag KG
Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

 

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