Subgroup analysis demonstrated similar trends , with higher freedom from AF in the surgical ablation group for paroxysmal AF patients .
The incidence of pacemaker implantation was higher , while no difference in stroke or cardiac tamponade was demonstrated for the surgical versus catheter ablation groups .
Current evidence suggests that epicardial ablative strategies are associated with higher freedom from AF , higher pacemaker implantation rates and comparable neurological complications and cardiac tamponade incidence to catheter ablative treatment .
BACKGROUND Atrial fibrillation ( AF ) is an increasingly prevalent condition in the ageing population , with significantly associated morbidity and mortality .
Surgical and catheter ablative strategies both aim to reduce mortality and morbidity through freedom from AF .
This review consoli date s all currently available comparative data to evaluate these two interventions .
Results of a Minimally Invasive Surgical Pulmonary Vein Isolation and Ganglionic Plexi Ablation for Atrial Fibrillation: Single-Center Experience With 12-Month Follow-Up
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 prospect ively 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 result ing 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
Subgroup analysis demonstrated similar trends , with higher freedom from AF in the surgical ablation group for paroxysmal AF patients .
The incidence of pacemaker implantation was higher , while no difference in stroke or cardiac tamponade was demonstrated for the surgical versus catheter ablation groups .
Current evidence suggests that epicardial ablative strategies are associated with higher freedom from AF , higher pacemaker implantation rates and comparable neurological complications and cardiac tamponade incidence to catheter ablative treatment .
BACKGROUND Atrial fibrillation ( AF ) is an increasingly prevalent condition in the ageing population , with significantly associated morbidity and mortality .
Surgical and catheter ablative strategies both aim to reduce mortality and morbidity through freedom from AF .
This review consoli date s all currently available comparative data to evaluate these two interventions .