| Abstract [eng] |
This is an observational, retrospective study of 127 patients (79 % males; mean age 52 ± 10 years [range, 23–75 years]) who underwent minimally invasive standalone surgical ablation of paroxysmal, persistent and longstanding persistent AF from 2008 to 2015. Mean follow-up was 60±21 months. Three different devices have been used for the ablation: Cardioblate® Gemini® surgical ablation system; Medtronic, Inc., Minneapolis, MN, USA; COBRA Adhere XL™ ablation system, Estech, Inc, California, CA, USA; AFx FLEX 10 microwave ablation system, Guidant, AFx, Fremont, CA, USA. The absence of arrhythmia was confirmed at 3, 6, and 12 months, and annually thereafter, with 24-hour Holter monitoring. The mean duration of preoperative AF was 6.5 ± 5.4 years. Six (5%) patients had a paroxysmal AF, and 19 patients (15%) had a long-standing persistent AF. Mean left atrial diameter was 4.3±0.8 cm. There were two postoperative strokes (2 %) and three conversions to median sternotomy (2.4%). Permanent pacemakers were implanted in 10 (8%) patients. There were no intra- or postoperative deaths. At 1, 2, 3, 4, and 5 years postoperatively, freedom from AF was 70%, 48%, 41%, 38%, 34%, 32% of patients, respectively. The best results were achieved then bipolar ablation device (Cardioblate® Gemini® surgical ablation system;) was used (χ2 = 12,521, p = 0.0004). At 1, 2, 3, 4, and 5 years postoperatively, freedom from AF was 73%, 58%, 48%, 44%, 42%, 42% of patients, respectively if bipolar ablation device was used.The failure to achieve pulmonary vein isolation (“exit” block) was the only independent predictor of long-term recurrence of AF (HR −3 [95 % CI 1,858 to 8,586], p = 0,001). Conclusions: In the present series, the efficacy of epicardial surgical ablation was similar to that reported previously. The rate of arrhythmia recurrence increased over time. Achieving pulmonary vein isolation is essential to AF elimination. |
