Point: Minimally invasive bipolar radiofrequency ablation of lone atrial fibrillation: Early multicenter results

Erik Beyer, Richard Lee, Buu Khanh Lam

Research output: Contribution to journalArticle

67 Citations (Scopus)

Abstract

Objective: The treatment of lone atrial fibrillation can be a minimally invasive procedure using bipolar radiofrequency ablation technologies. Our objectives were to report on the safety and early efficacy of this novel therapeutic modality. Methods: At 3 North American institutions between February 2005 and August 2007, 100 patients underwent minimally invasive bilateral pulmonary vein isolation, autonomic denervation, and left atrial appendage resection. The mean age was 65 ± 11 years, and 70% were male. The median duration of atrial fibrillation was 5.0 years; atrial fibrillation was paroxysmal in 39 patients (39%), persistent in 29 patients (29%), and permanent in 32 patients (32%). Indications for surgery included failure of medical therapy or percutaneous ablation and severe symptoms. Mean follow-up was 13.6 ± 8.2 months. Results: The mean operative time was 253 ± 65 minutes, and the median hospital length of stay was 5 days. There were no intraoperative conversions and no mortality to report. Postoperative complications included pacemaker requirement in 5 patients (5%), phrenic nerve palsy in 3 patients (3%), hemothorax in 3 patients (3%), transient ischemic attack in 1 patient (1%), and pulmonary embolism in 1 patient (1%). At follow-up, 87% of patients were in normal sinus rhythm (paroxysmal 93%, persistent 96%, permanent 71%; P < .05); antiarrhythmic therapy was discontinued in 62% of patients, and anticoagulation therapy was discontinued in 65% of patients. Conclusion: Minimally invasive bipolar radiofrequency ablation of lone atrial fibrillation is a safe and efficacious therapeutic option in selected patients. Further development is needed to reduce the rate of complications. Long-term prospective results are required to further validate this modality as a therapeutic option to treat lone atrial fibrillation.

Original languageEnglish (US)
Pages (from-to)521-526
Number of pages6
JournalJournal of Thoracic and Cardiovascular Surgery
Volume137
Issue number3
DOIs
StatePublished - Mar 1 2009
Externally publishedYes

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Atrial Fibrillation
Therapeutics
Autonomic Denervation
Length of Stay
Hemothorax
Atrial Appendage
Phrenic Nerve
Pulmonary Veins
Transient Ischemic Attack
Operative Time
Pulmonary Embolism
Paralysis
Technology
Safety

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Point : Minimally invasive bipolar radiofrequency ablation of lone atrial fibrillation: Early multicenter results. / Beyer, Erik; Lee, Richard; Lam, Buu Khanh.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 137, No. 3, 01.03.2009, p. 521-526.

Research output: Contribution to journalArticle

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abstract = "Objective: The treatment of lone atrial fibrillation can be a minimally invasive procedure using bipolar radiofrequency ablation technologies. Our objectives were to report on the safety and early efficacy of this novel therapeutic modality. Methods: At 3 North American institutions between February 2005 and August 2007, 100 patients underwent minimally invasive bilateral pulmonary vein isolation, autonomic denervation, and left atrial appendage resection. The mean age was 65 ± 11 years, and 70{\%} were male. The median duration of atrial fibrillation was 5.0 years; atrial fibrillation was paroxysmal in 39 patients (39{\%}), persistent in 29 patients (29{\%}), and permanent in 32 patients (32{\%}). Indications for surgery included failure of medical therapy or percutaneous ablation and severe symptoms. Mean follow-up was 13.6 ± 8.2 months. Results: The mean operative time was 253 ± 65 minutes, and the median hospital length of stay was 5 days. There were no intraoperative conversions and no mortality to report. Postoperative complications included pacemaker requirement in 5 patients (5{\%}), phrenic nerve palsy in 3 patients (3{\%}), hemothorax in 3 patients (3{\%}), transient ischemic attack in 1 patient (1{\%}), and pulmonary embolism in 1 patient (1{\%}). At follow-up, 87{\%} of patients were in normal sinus rhythm (paroxysmal 93{\%}, persistent 96{\%}, permanent 71{\%}; P < .05); antiarrhythmic therapy was discontinued in 62{\%} of patients, and anticoagulation therapy was discontinued in 65{\%} of patients. Conclusion: Minimally invasive bipolar radiofrequency ablation of lone atrial fibrillation is a safe and efficacious therapeutic option in selected patients. Further development is needed to reduce the rate of complications. Long-term prospective results are required to further validate this modality as a therapeutic option to treat lone atrial fibrillation.",
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