Author + information
- A. Baimbetov,
- T. Bozshagulov,
- R. Tuleutayev,
- B. Rakishev and
- R. Taimanova
Aims of this study to estimate first results of thoracoscopic radiofrequency ablation (isolation of pulmonary veins and LA posterior wall) with or without LAA exclusion for long standing persistent atrial fibrillation.
During 2016 year, 13 patients with long standing persistent AF underwent to thoracoscopic epicardial radiofrequency ablation (isolation of pulmonary veins and LA posterior wall) with or without LAA exclusion (Medtronic GeminiS). Operation technique included ablation of pulmonary veins, Marshall's ligament coagulation, resection of left atrial appendage and epicardial mapping to identify exit block and entrance block. Contraindications were: left atrial appendage thrombosis (for monopolar ablation), weakness of the sinus node, adhesive process in pericardium, adhesive process in pleural cavity, chronic obstructive bronchitis of the lungs (difficult long term one lung ventilation), atrium size less than 55mm. 13 patients: 9 men,4 women, mean age 58 years (33-74 years), long standing persistent AF-12 patients, persisten AF-1 patient, mean time of AF-4.2 years (3 month-20 years), mean size of left atrium 4.3±0,9cm, primary catheter ablation were done in 5 patients, EF LV 54% (36-67%), mitral regurgitation was in 3 patients, LV EDV-148 ml (101-223ml). After operation all patients were treated with amiodarone 200 mg per day and anticoagulation therapy with warfarine 6 months. Control efficacy of the treatment were done by 24-Hour Holter Monitor during 1,3,6 months after operation, mean time of follow-up 180 ±19 days.
All patients were on sinus rhythm after operation and up to 6 months. Average time of hospital stay 8 days. One patient was readmitted to the hospital due to atrial flutter which was treated in CathLab by ablation of cava-tricuspid isthmus. Recurrent atrial fibrillation after 6 months was in 1 patient. No other perioperative complication was reported. All patients underwent a 24 hr Holter monitoring 2nd day postoperatively: no relapse of tachycardia. All patients were discharged in good condition on 4th or 5th day postoperatively.
Thoracoscopic ablation of pulmonary veins is a perspective method of treatment atrial fibrillation, with high efficacy 90,9% in mid-term follow-up, especially in non effective catheter ablation, with low complications and fast recovery period. Exclusion of LAA reduces thromboembolic complications in case of recurrent atrial fibrillation.