Thoracoscopic radiofrequency ablation for lone atrial fibrillation: box-lesion technique

We report the feasibility and outcomes of box-lesion ablation technique to treat stand-alone atrial fibrillation (AF).

There were 41 patients with a mean age of 57.6 ± 8.0 years who underwent bilateral totally thoracoscopic ablation of symptomatic paroxysmal AF (n = 24; 58.5%), persistent AF (n = 9; 22.0%), or long-standing persistent AF (n = 8; 19.5%). The box-lesion procedure included bilateral pulmonary vein and left atrial posterior wall ablation using irrigated bipolar radiofrequency with documentation of conduction block.

There were no intra- or perioperative ablation-related complications. There was no operative mortality, no myocardial infarction, and no stroke. Skin-to-skin procedure time was 119.5 ± 23.7 minutes and the postoperative average length of stay was 7.4 ± 2.5 days. At discharge, 38 patients (93%) were in sinus rhythm. Median follow-up time was 641 days (ranges, 185-1636 days). At six months postsurgery, 31 patients of 41 (76%) were free from AF without the need of antiarrhythmic drugs. One-year success rate was 73% (off antiarrhythmic drugs). Eight patients (19.5%) underwent catheter reablation. Thirty-six patients (90%) were in sinus rhythm at six months after the last performed ablation (surgical ablation or catheter reablation). At 12 months follow-up, 61% patients discontinued oral anticoagulant therapy.

The thoracoscopic box-lesion ablation procedure is a safe, effective, and minimally invasive method for the treatment of isolated (lone) AF. This procedure provided excellent short-term freedom from AF.