School of Medicine
Cardiovascular and Thoracic Surgery
Background: The aim of this study is to report the long-term efficacy and safety of thoracoscopic epicardial left atrial ablation (TELA) in patients with paroxysmal atrial fibrillation (AF). Methods: This was a retrospective review of medical records. We included all patients diagnosed with paroxysmal AF who underwent TELA at our institution between 04/2011 and 06/2017. TELA included pulmonary vein isolation, LA dome lesions and LA appendage exclusion. All (n = 55) patients received an implantable loop recorder (ILR), 30 days post-operatively. Antiarrhythmic and anticoagulation therapy were discontinued at 90 and 180 days postoperatively, respectively, if patients were free of AF recurrence. Failure was defined as ≥two minutes of continuous AF, or atrial tachycardia. Results: Fifty-five patients (78% males, mean age = 61.6 years) qualified for the study. The average duration in AF was 3.64 +/− 3.4 years, mean CHA2DS2-VASc Score was 2.0 +/− 1.6. The procedure was attempted in 57 patients and completed successfully in 55 (96.5%). Two patients experienced a minor pulmonary vein bleed that was managed conservatively. Post procedure, one patient experienced pulmonary edema, another experienced a pneumothorax requiring a chest tube and another experienced acute respiratory distress syndrome resulting in longer hospitalization. Otherwise, there were no major procedural complications. Success rates were 89.1% (n = 49/ 55), 85.5% (n = 47/55) and 76.9% (n = 40/52) at 6, 12 and 24 months, respectively. In the multivariate coxproportional hazard model, survival at the mean of covariates was 86 and 74% at 12 and 24 months, respectively. Conclusion: In this single center experience, TELA was a safe and efficacious procedure for patients with paroxysmal AF.
Digital Commons Citation
Johnkoski, John; Miles, Bryan; Sudbury, Anna; Osman, Mohammed; Munir, Muhammad Bilal; Balla, Sudarshan; and Benjamin, Mina M., "Safety and Long-term Efficacy of Thoracoscopic Epicardial Ablation in Patients with Paroxysmal Atrial Fibrillation: A Retrospective Study" (2019). Faculty & Staff Scholarship. 1486.
Johnkoski, J., Miles, B., Sudbury, A. et al. Safety and long-term efficacy of thoracoscopic Epicardial ablation in patients with paroxysmal atrial fibrillation: a retrospective study. J Cardiothorac Surg 14, 188 (2019). https://doi.org/10.1186/s13019-019-1018-4