Related Experiment Video
Updated: Dec 3, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Left Atrial Appendage Thrombosis and Persistent Atrial Fibrillation: combined Treatment with a Totally Thoracoscopic
Igor Vendramin1, Andrea Lechiancole1, Luca Rebellato1
1Cardiothoracic Department, University Hospital of Udine, Udine, Italy.
Insights
This study introduces a novel minimally invasive ablation technique for patients with atrial fibrillation and left atrial appendage thrombosis. The innovative bilateral video-thoracoscopic approach successfully treated patients, maintaining stable sinus rhythm and excluding the appendage.
Area of Science:
- Cardiology
- Minimally Invasive Surgery
- Electrophysiology
Background:
- Atrial fibrillation (AF) management is challenging in patients with left atrial appendage (LAA) thrombosis.
- Standard minimally invasive surgical ablation is often contraindicated due to LAA thrombosis.
- Limited treatment options exist for these complex AF cases.
Purpose of the Study:
- To evaluate the safety and efficacy of a novel bilateral video-thoracoscopic ablation technique.
- To treat persistent atrial fibrillation in patients with LAA thrombosis.
- To simultaneously exclude the LAA during ablation.
Main Methods:
- A bilateral video-thoracoscopic approach was employed in three patients.
- Radio-frequency ablation created a continuous encircling lesion at the pulmonary vein outflow.
- The left atrial appendage was simultaneously excluded during the procedure.
Main Results:
- The postoperative course was uneventful in all patients.
- No neurologic events were observed postoperatively.
- All patients maintained stable sinus rhythm at the 1-year follow-up.
Conclusions:
- This innovative technique offers a new minimally invasive option for persistent AF.
- It is suitable for patients with LAA thrombosis who are otherwise contraindicated for ablation.
- The procedure demonstrates promising safety and efficacy in this challenging patient group.
Abstract:
Minimally invasive surgical ablation is generally contraindicated in patients with atrial fibrillation and thrombosis of the left atrial appendage. We have treated three of these patients using an innovative technique based on a bilateral video-thoracoscopic approach, performing a continuous encircling lesion at the pulmonary veins outflow with radio-frequency ablation, simultaneously excluding the left atrial appendage. The postoperative course was uneventful, without neurologic events and all patients maintained a stable sinus rhythm at 1-year follow-up. This procedure represents a new mini-invasive method to treat persistent atrial fibrillation when partial thrombosis of the left atrial appendage contraindicates other ablation techniques.
