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Original Articles

Results of a Minimally Invasive Surgical Pulmonary Vein Isolation and Ganglionic Plexi Ablation for Atrial Fibrillation

Single-Center Experience With 12-Month Follow-Up

Frederick T. Han, MD; Vigneshwar Kasirajan, MD; Marcin Kowalski, MD; Robert Kiser, MD; Luke Wolfe, MS; Gautham Kalahasty, MD; Richard K. Shepard, MD; Mark A. Wood, MD and Kenneth A. Ellenbogen, MD

From the Department of Medicine (Cardiology) (F.T.H., M.K., R.K., G.K., R.K.S., M.A.W., K.A.E.) and Department of Medicine (Cardiac Surgery) (V.K., L.W.), Medical College of Virginia, Richmond, Va.

Correspondence to Kenneth A. Ellenbogen, MD, Medical College of Virginia, PO Box 980053, Richmond, VA 23298-0053. E-mail kellenbogen{at}mcvh-vcu.edu

Received February 2, 2009; accepted May 29, 2009.

Background— The Cox Maze procedure for treatment of medically refractory atrial fibrillation (AF) is limited by its complexity and requirement for cardiopulmonary bypass. Long-term follow-up and success using criteria established by the Heart Rhythm Society/European Heart Rhythm Association/European Cardiac Arrhythmia Society consensus statement have not been reported for surgical AF ablation. We describe the results of using a thorascopic approach and radiofrequency energy to perform bilateral pulmonary vein isolation and left atrial ganglionic plexi ablation for treatment of AF.

Methods and Results— Forty-five (33 paroxysmal; 12 persistent) consecutive patients underwent thorascopic bilateral radiofrequency pulmonary vein isolation, ganglionic plexi ablation, ligament of Marshall ablation, and left atrial appendage exclusion by a single surgeon. Forty-three patients were prospectively followed without antiarrhythmic drugs for a minimum of 1 year with a 30-day continuous event monitor or pacemaker interrogation at 6 and 12 months. Failure was defined as any atrial tachyarrhythmia of >30 seconds’ duration occurring >90 days after surgery. Mean follow-up was 516±181 days (202 to 858 days). Twenty-eight (65%) patients had no atrial tachyarrhythmia >30 seconds by 1 year, and 15 (35%) patients had atrial tachyarrhythmia recurrences by 1 year. Eight of 15 patients with recurrent AF had catheter ablation resulting in elimination and/or reduction of AF episodes in 7 of 8 patients. Four of 15 patients had AF elimination or reduction with antiarrhythmic drugs alone. Three patients did not benefit from surgery and received rate control only. There were no deaths; 1 phrenic nerve injury and 2 pleural effusions were the only major complications.

Conclusions— The single procedure success at 1-year follow-up for surgical pulmonary vein isolation and ganglionic plexi ablation is 65%. Atrial tachyarrhythmia recurrences after surgery are usually responsive to catheter ablation and/or antiarrhythmic drugs.

Key Words: atrial fibrillation • surgical ablation • cardiac monitoring • catheter ablation

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CLINICAL PERSPECTIVE

Clinical trial registration information: www.ClinicalTrials.gov. ClinicalTrials.gov identifier: NCT00747838.

The online-only Data Supplement is available at http://circep.ahajournals.org/cgi/content/full/CIRCEP.109.854828/DC1.