Abstract 3252: Thoracoscopic Epicardial Pulmonary Vein Isolation Is A Realistic Alternative For Endocardial Radiofrequency Ablation: Lower Risk Of Arterial Embolism And Shorter Procedure Times
Background Pulmonary veins isolation (PVI) has become an established treatment for atrial fibrillation (AF). However, post-procedural complications by cerebroembolic events might occur. In order to evaluate the cause of these complications we compared the number of cerebral microemboli during two approaches of PVI; epicardial microwave ablation and percutaneous endocardial radiofrequency ablation in patients with AF.
Methods and Results Eight patients underwent a right 3 port mono-lateral thoracoscopic epicardial microwave (MW) ablation on the beating heart of the 4 pulmonary veins and the posterior left atrium. Twelve patients underwent endocardial RF ablation of the 4 pulmonary veins. Transcranial Doppler was used in all patients to detect cerebral MES. There was no significant difference in total ablation time between the two groups. However, the total procedural time was significant longer in the percutaneous endocardial PVI approach. Stroke or CVA was not reported in any of the patients. The average of 4 (± 7) cerebral MES per patient during the epicardial ablation is highly significantly lower than the 2703 (± 1919) cerebral MES during percutaneous endocardial RF ablation.
Conclusion Cerebral MES were almost absent during thoracoscopic epicardial microwave ablation for the treatment of AF. This finding is in sharp contrast with the abundant MES detected during percutaneous endocardial RF ablation. Due to a positive association between the number of MES and cerebral complications, the striking difference of the amount of MES and the absence of thrombus formation might indicate a comparatively low risk of cerebrovascular complications for the epicardial approach as compared to the percutaneous approach. Since the success rates of both PVI approaches is reported to be around 80%, the shorter procedural time and the absence of cerebral MES render the thorascopic epicardial microwave approach a realistic alternative for endocardial RF ablation.