Safety and long-term efficacy of thoracoscopic Epicardial ablation in patients with paroxysmal atrial fibrillation: a retrospective study

摘要

Abstract BackgroundThe aim of this study is to report the long-term efficacy and safety of thoracoscopic epicardial left atrial ablation (TELA) in patients with paroxysmal atrial fibrillation (AF).MethodsThis was a retrospective review of medical records. We included all patients diagnosed with paroxysmal AF who underwent TELA at our institution between 04/2011 and 06/2017. TELA included pulmonary vein isolation, LA dome lesions and LA appendage exclusion. All ( n =?55) patients received an implantable loop recorder (ILR), 30?days post-operatively. Antiarrhythmic and anticoagulation therapy were discontinued at 90 and 180?days postoperatively, respectively, if patients were free of AF recurrence. Failure was defined as ≥two minutes of continuous AF, or atrial tachycardia.ResultsFifty-five patients (78% males, mean age?=?61.6?years) qualified for the study. The average duration in AF was 3.64 +/??3.4?years, mean CHA2DS2-VASc Score was 2.0 +/??1.6. The procedure was attempted in 57 patients and completed successfully in 55 (96.5%). Two patients experienced a minor pulmonary vein bleed that was managed conservatively. Post procedure, one patient experienced pulmonary edema, another experienced a pneumothorax requiring a chest tube and another experienced acute respiratory distress syndrome resulting in longer hospitalization. Otherwise, there were no major procedural complications. Success rates were 89.1% ( n =?49/55), 85.5% ( n =?47/55) and 76.9% ( n =?40/52) at 6, 12 and 24?months, respectively. In the multivariate cox-proportional hazard model, survival at the mean of covariates was 86 and 74% at 12 and 24?months, respectively.ConclusionIn this single center experience, TELA was a safe and efficacious procedure for patients with paroxysmal AF.