Background
Minimally invasive surgical atrial fibrillation (AF) ablation (MISAA) delivers radiofrequency
energy via a thoracoscopic approach to perform pulmonary vein isolation and left atrial
ganglionic plexi ablation. Data on long-term outcomes of MISAA are lacking.
Objective
We report 5-year follow-up data from a prospective cohort of patients who underwent
MISAA at a single center.
Methods
One hundred nine consecutive patients (60 paroxysmal, 49 persistent; mean age 62.7
± 9.3 years) underwent MISAA with left atrial appendage exclusion by a single surgeon
between 2006 and 2012. Patients were followed with transtelephonic monitoring at 1,
6, and 12 months and annually thereafter for up to 5 years. Recurrence was defined
as any atrial tachyarrhythmia lasting ≥30 seconds from 90 days after surgery onward.
Results
Mean follow-up duration was 1738.5 ± 661.5 days. Single-procedure success rate was
38% (37 of 98 patients). Atrial arrhythmias occurred in 22%, 42%, 55%, 59%, and 62%
of patients by 1, 2, 3, 4, and 5 years. Seventy-eight (79.6%) patients remained AF
free with or without additional interventions including catheter ablation, antiarrhythmic
drugs, or cardioversion. There was no significant difference in AF-free survival between
paroxysmal and persistent AF groups (P = .725). Multivariate analyses showed hypertension to be a significant predictor
of AF recurrence (odds ratio 6.6, confidence interval 1.41–30.80; P = .016). Five (5.1%) patients had a stroke or transient ischemic attack during follow-up.
Conclusion
AF-free survival was 38% at 5 years after MISAA. A total of 79.6% of patients remained
AF free with or without additional intervention. Patients may have an ongoing risk
of stroke even in the absence of AF recurrences.
Keywords
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Article info
Publication history
Published online: April 21, 2017
Footnotes
Conflicts of interest: Dr Kasirajan received honoraria and research support from Atricure Inc. Dr Ellenbogen received honoraria and research support from Atricure Inc, Ablation Frontiers, Biosense Webster, Medtronic, Boston Scientific, and St. Jude Medical.
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© 2017 Heart Rhythm Society. All rights reserved.
