Modified thoracoscopic ablation procedure for the treatment of AF

Amiran Sh. Revishvili , Vadim A. Popov , Egor S. Malyshenko, Maksim M. Anishchenko, Natalia V. Popova, Sirarpi S. Petrosyan

A.V. Vishnevsky National Medical Research Center of Surgery Moscow, Russian Federation

Objective. This study compared outcomes of a modified thoracoscopic ablation (TSA) procedure versus conventional TSA for the treatment of AF.

Material and methods. The propensity score match (PSM) analwas conducted in 340 patients after TSA. 1^st group (n=107) underwent conventional procedure , while 2^nd group (n=233) received a modified procedure with complete posterior LA isolation.  After PSM analysis 88 pairs of patient were obtained. The primary endpoint was the freedom from AF/AT/PT  at discharge and during mid-term follow-up (up to 36 mo). Secondary endpoints included the rate of conversion to sternotomy and the rate of permanent pacemaker implantation (PPI).

Results. After PSM analysis there was no in-hospital mortality in either group. The rate of sinus rhythm at discharge was significantly higher in 2^nd group compared to 1^st group (95.4% vs. 86.4%, p=0.035). In 1^st group I, there were 2 (2.3%) complication requiring sternotomy, while in 2^nd group II there were no conversions (p = 0.497).In 1^st  case in 2^nd group (1.1%)  required patient PPI  during  hospitalization. Cumulative freedom from AF/AT/PT recurrence was significantly higher in Group II compared to Group I: 98% vs 84.9% (at 12 mo); 91% vs 62% (at 24 mo); and 84.6% vs 62% (at 36 mo), p = 0.004. There were no cases of PPI during mid-term follow-up.

Conclusions. TA is an effective and relatively safe treatment for isolated forms of AF. Modification of the technique with complete isolation of the posterior wall of the LA significantly improves the mid-term results.