Video-assisted epicardial ablation and left atrial appendage exclusion for atrial fibrillation: extended follow-up

New ablation technologies have spurred development of less invasive operations for atrial fibrillation. The long-term efficacy of these procedures is unknown.

This was a retrospective study of 22 patients aged 63 +/- 9 years with symptomatic, intermittent atrial fibrillation who underwent video-assisted, thoracoscopic pulmonary vein isolation and left atrial appendage exclusion from April 2004 through July 2005. The procedure consisted of bilateral 10-mm ports and 5-cm non-rib-spreading working ports. The left atrial appendage was excised with a surgical stapler. All patients were followed for at least 1 year, and all underwent Holter monitoring at study end point.

The procedure was performed safely in all patients. One patient did not undergo left atrial appendage excision because of preexisting adhesions. No stroke, reoperation for bleeding, or patient mortality occurred. Average hospital stay was 3.2 +/- 2.0 days (range, 2 to 10 days). No patient required repeat atrial fibrillation ablation. One patient underwent right atrial flutter ablation 7 months postoperatively. Average follow-up time was 18.1 +/- 4.1 months (range, 12 to 27 months). At the end of follow-up, 20 patients (91%) were free of symptoms without antiarrhythmic therapy. Holter monitoring in these patients (performed more than 6 months after cessation of antiarrhythmic drugs) showed sinus rhythm and no atrial fibrillation. Twenty patients (91%) were no longer taking warfarin at the end of the study period.

Bilateral, video-assisted, thoracoscopic pulmonary vein isolation with left atrial appendage exclusion has favorable single-procedure efficacy after extended follow-up for selected patients with atrial fibrillation.