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Ann Thorac Surg 2008;86:35-39. doi:10.1016/j.athoracsur.2008.03.071
© 2008 The Society of Thoracic Surgeons
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James R. Edgerton
Syma Prince
Michael J. Mack
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Right arrow Electrophysiology - arrhythmias

Original Articles: Adult Cardiac

Minimally Invasive Pulmonary Vein Isolation and Partial Autonomic Denervation for Surgical Treatment of Atrial Fibrillation

James R. Edgerton, MD*, Zachary J. Edgerton, Tara Weaver, RN, Kellie Reed, BS, Syma Prince, RN, Morley A. Herbert, PhD, Michael J. Mack, MD

Cardiopulmonary Research Science and Technology Institute, Dallas, Texas

Accepted for publication March 28, 2008.

* Address correspondence to Dr J. R. Edgerton, 4708 Alliance Blvd, Suite 700, Plano, TX 75093 (Email: edgertonjr{at}aol.com).

Presented at the Forty-fourth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–30, 2008.

Background: We seek to demonstrate the rationale and efficacy of a minimally invasive surgical approach to the treatment of atrial fibrillation (AF) that combines pulmonary vein antral isolation with targeted partial autonomic denervation.

Methods: The literature supporting the rationale of this approach is reviewed. Seventy-four patients underwent video-assisted bilateral pulmonary vein antral isolation with confirmation of block and partial autonomic denervation with follow-up of 6 months or greater and have a long-term rhythm monitor at 6 months.

Results: Success was defined as no episodes greater than 15 seconds of AF on long-term monitoring. Treatment was successful in 83.7% of patients with paroxysmal AF and 56.5% of patients with persistent/long-standing persistent AF.

Conclusions: There are evidence-based data that support both pulmonary vein electrical isolation and targeted partial autonomic denervation in the treatment of AF. These techniques can be combined in a minimally invasive surgical approach. Early data suggest this is a safe and efficacious approach for the treatment of paroxysmal AF. Techniques are being developed for the minimally invasive surgical treatment of persistent AF from an epicardial approach.




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