Abstract 5687: Toward a Definitive, Totally Thoracoscopic Procedure for Atrial Fibrillation
Evolution of anti-arrhythmia surgery beyond the Cox-Maze III has been hampered by the difficulty in implementing a complete lesion set in a truly minimally invasive approach. Specifically, minimal access procedures for atrial fibrillation have inadequately treated the anatomic substrate prominent in advanced atrial fibrillation. In this study, we introduce a true port-access procedure which addresses both autonomic and anatomic sources of atrial fibrillation, with real-time verification of all technical endpoints. A total of 32 patients with longstanding persistent or permanent atrial fibrillation underwent the totally thoracoscopic anti-arrhythmia procedure incorporating pulmonary vein isolation, mapping of epicardial autonomics, extended linear ablations across critical segments of atrial substrate, and ligation of the left atrial appendage. All aspects of the procedure were confirmed with intraoperative electrophysiologic testing. There were no mortalities. One patient required a median sternotomy to repair a retraction injury to the left atrial appendage. Rhythm surveillance consisted of one week of continuous event monitoring at three, six and thirteen months postoperatively in all patients. Of the 24 patients with six month follow-up, 21 are in sinus rhythm with no anti-arrhythmia medications. The actuarial freedom from atrial fibrillation is 87.5%. None of the patients required a pacemaker. An anti-arrhythmia operation which is highly effective in patients with advanced forms of atrial fibrillation can be safely performed through a totally port-access approach.