Surgical minimally invasive pulmonary vein isolation for lone atrial fibrillation: midterm results of a multicenter study

• Published in: Innovations (Philadelphia, Pa.) Pa.), 2013-11, Vol.8 (6), p.410-415
• Main Authors: De Maat, Gijs E, Pozzoli, Alberto, Scholten, Marcoen F, Hillege, Hans L, Van Gelder, Isabelle C, Alfieri, Ottavio R, Benussi, Stefano, Mariani, Massimo A
• Format: Article
• Language: English
• Subjects: Atrial Fibrillation - physiopathology; Atrial Fibrillation - surgery; Electrocardiography, Ambulatory; Female; Follow-Up Studies; Heart Conduction System - physiopathology; Heart Conduction System - surgery; Humans; Male; Middle Aged; Pulmonary Artery - surgery; Retrospective Studies; Tachycardia, Paroxysmal - physiopathology; Tachycardia, Paroxysmal - surgery; Thoracic Surgery, Video-Assisted - methods; Time Factors; Treatment Outcome; Vascular Surgical Procedures - methods
• ISSN: 1556-9845; 1559-0879
• DOI: 10.1097/IMI.0000000000000029

Minimally invasive surgical pulmonary vein isolation (SMI-PVI) is an emerging therapy for the treatment of symptomatic drug-refractory atrial fibrillation (AF). Nevertheless, the midterm and long-term results of SMI-PVI remain unknown. The aim of this retrospective multicenter study was to report on midterm efficacy and safety of SMI-PVI. The study design was retrospective, multicentric, and observational. From July 2005 to November 2011, a total of 86 patients with drug-refractory paroxysmal or persistent AF underwent SMI-PVI in three centers. Patients were eligible for SMI-PVI if they had symptomatic, drug-refractory AF or after failed transcatheter pulmonary vein isolation. Success was defined as absence of AF on 24- or 96-hour Holter monitoring during follow-up, in the absence of antiarrhythmic drugs (AADs). The mean ± SD age was 54 ± 11 years, and 78% were men. The median AF duration was 30 months (range, 2-203); paroxysmal AF was present in 86% of the patients, persistent in 14%. Fifteen patients (17%) underwent previous transcatheter ablations. After a median follow-up of 24 months (range, 6-78), 72% of all patients were free from atrial arrhythmias without the use of AADs. With AADs, this was 83%. Major perioperative adverse events occurred in 7 patients (8%). This retrospective multicenter study shows that SMI-PVI is effective at a median follow-up of 24 months for the treatment of mostly paroxysmal drug-refractory AF. Perioperative adverse events do remain a point of caution.