Mid-term outcomes of thoracoscopic and hybrid therapy of atrial fibrillation

Aim. To evaluate the efficacy and safety of thoracoscopic and hybrid techniques in patients with various forms of atrial fibrillation (AF).

Methods. The results of thoracoscopic ablation of 87 patients with AF were analyzed: 27 (31%) with paroxysmal form, 15 (17%) - with persistent, 45 (52%) - with long-term persistent form at follow-up 18.6±6.7 months. “Box-Lesion” treatments and amputation of left atrial appendage (LAA) were performed in 69 (79.3%) patients, “Box Lesion” without LAA amputation in 12 (13.7%). When atrial tachycardia was recorded for more than 30 seconds after a 3-month “blind” period, patients underwent hybrid catheter intervention.

Results. Freedom from atrial arrhythmias in the group of paroxysmal AF was achieved in 84% of patients (21 of 25), in the group of persistent form - in 60% of patients (9 of 15), in the group of long-term persistent form - in 78% (32 of 41) at a given observation period. In the structure of postoperative atrial tachycardia, AF recurrence was 5 (6.25%), typical atrial flutter (AFL) - 3 (3.75%), atypical AFL - 10 (12.5%). The mean LA volume index in patients with stable sinus rhythm was 64.6±11.3 ml/m2 versus 74.65±15.4 ml/m2 in the atrial tachycardia group (Student’s t-test 0.53, p = 0.6). These patients underwent a hybrid intervention. At a follow-up period of 15.9±10.9 months, a stable sinus rhythm was maintained in 15 (83.3%) patients. The overall rate of intra- and postoperative complications of thoracoscopic ablation was 5.7%.

Conclusion. Thoracoscopic and hybrid approaches are effective methods for various forms of AF treatment.

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