Ann Thorac Surg 2007;84:1795. doi:10.1016/j.athoracsur.2007.06.092
© 2007 The Society of Thoracic Surgeons
Correspondence
Treatment of Atrial Fibrillation With a Right Thoracoscopic Approach
Yoshito Inoue, MD
Department of Cardiovascular Surgery, Saiseikai Utsunomiya Hospital, 911-1 Takebayashi, Utsunomiya, Tochigi 321-0974, Japan
(Email: yosito_inoue{at}saimiya.com).
To the Editor:
I read with great interest the article by Meir and coworkers [1] regarding the right thoracoscopic approach for left atrial circular ablation [1]. However, there seems to be several drawbacks to this approach because the authors simplified the procedure at the sacrifice of a left-sided surgical view.
First, creation of linear transmural conduction block lesion is likely to be incomplete on the blind side due to imperfect tissue-electrode contact and due to fat and pericardial tissue left after insufficient blind dissection [2].
Second, blind blunt dissection around fragile left pulmonary veins may involve a risk of inadvertent bleeding, which would be difficult to bail out of immediately under a right-sided approach.
Third, malpositioning of the linear electrode may lead to heat injury to the circumflex coronary artery and left pulmonary veins [3].
Direct vision of the left lateral wall of the left atrium would solve these problems. Video-assisted imaging of the blind side from the right chest cavity could be obtained by additional flexible cardioscopic guidance [4], inserted through a port and suitably angled toward the left lateral wall of the left atrium. Cardioscopic guidance would help to confirm the fine dissection and placement of the linear conduction block line directly. Combined with cardioscopic guidance, a right thoracoscopic approach would be more safe and reliable and might find a wider application with better surgical results.
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References
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- Meir ML, Roy DL, Blommaert D, Buche M. Treatment of lone atrial fibrillation with a right thoracoscopic approach Ann Thorac Surg 2007;83:2244-2245.[Abstract/Free Full Text]
- Inoue Y, Yozu R, Cho Y, Kawada S. Video-assisted thoracoscopy system guidance in linear radiofrequency ablation Surg Today 2000;30:811-815.[Medline]
- Inoue Y, Kiso I, Takahashi R, Mori A, Motogami K. Beating-heart epicardial radiofrequency ablation: optimal temperature setting Ann Thorac Surg 2004;78:308-312.[Abstract/Free Full Text]
- Inoue Y, Yozu R, Onoguchi K, Kabei N, Takeuchi S, Kawada S. Cardioscopic guidance of linear lesion creation for radiofrequency ablation Ann Thorac Surg 2003;75:1189-1193.[Abstract/Free Full Text]
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