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Ann Thorac Surg 2012;94:1886-1892. doi:10.1016/j.athoracsur.2012.07.035
© 2012 The Society of Thoracic Surgeons
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Timo Weimar
Markus Czesla
Wolfgang B. Hemmer
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Original Articles: Adult Cardiac

Approaching a Paradigm Shift: Endoscopic Ablation of Lone Atrial Fibrillation on the Beating Heart

Timo Weimar, MD*, Martina Vosseler, RN, Markus Czesla, MD, Margaretha Boscheinen, MD, Wolfgang B. Hemmer, MD, Kai-Nicolas Doll, MD

Department of Cardiac Surgery, Sana Cardiac Surgery Stuttgart GmbH, Stuttgart, Germany

Accepted for publication July 11, 2012.

* Address correspondence to Dr Weimar, Sana Cardiac Surgery Stuttgart GmbH, Herdweg 2, 70174 Stuttgart, Germany (Email: timo.weimar{at}yahoo.de).

Background: Percutaneous catheter ablation has been the preferred treatment strategy for many patients with symptomatic drug-refractory atrial fibrillation (AF). However, incomplete ablation lines and varying success rates remain a problem in certain subgroups. This article evaluates the feasibility and efficacy of endoscopically performed left atrial ablation in patients with lone AF.

Methods: Epicardial bipolar radiofrequency ablation was performed on the beating heart through a bilateral endoscopic approach in 89 consecutive patients with lone AF. This included isolation of the pulmonary veins using a clamp; isolation of the posterior left atrial wall, including a trigonal line to the aortic noncoronary sinus using a linear ablation device; and resection of the left atrial appendage (LAA). Preoperative, perioperative, and postoperative data were collected prospectively and included questionnaires and 24-hour Holter monitoring at 6 and 12 months and annually thereafter.

Results: Mean follow-up was 12 ± 6 months (range, 4–28 months). No patients were lost to follow-up. Mean duration of AF was 6.4 ± 5.7 years, with 35% paroxysmal AF and 65% persistent or long-standing persistent AF. Mean operation time was 180 ± 43 minutes. There were no deaths, no conversion to sternotomy, and no early or late stroke. Freedom from AF was 88%, 90%, and 90% at 6, 12, and 24 months, respectively. Freedom from AF without antiarrhythmic drugs was 71%, 82%, and 90% at 6, 12, and 24 months, respectively.

Conclusions: Endoscopic radiofrequency ablation on the beating heart reveals high success rates with low procedure-related morbidity. For improvement of future treatment strategies, a randomized trial is advisable to compare this procedure with catheter ablation in certain patient subgroups.


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Invited Commentary
George L. Hicks, Jr
Ann. Thorac. Surg. 2012 94: 1892-1893. [Extract] [Full Text] [PDF]



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G. L. Hicks Jr
Invited Commentary
Ann. Thorac. Surg., December 1, 2012; 94(6): 1892 - 1893.
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