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 .
Surgical vs. transcatheter pulmonary vein isolation as first invasive treatment in patients with atrial fibrillation: a matched group comparison.
AIMS Pulmonary vein isolation ( PVI ) can be considered for treatment of symptomatic atrial fibrillation ( AF ) . Nowadays , in addition to transcatheter ablation , thoracoscopic surgical PVI is available . The aim of this study is to compare clinical outcome of surgical with transcatheter PVI as first invasive treatment strategy of AF . METHODS AND RESULTS From June 2009 to November 2011 , 33 patients underwent minimally invasive surgical PVI , and were matched ( 1:2 fashion ) retrospectively according to age , sex , and AF type , with 66 patients who underwent transcatheter PVI .  Success was defined as freedom from atrial arrhythmias on 24 h Holter monitoring without use of anti-arrhythmic drugs ( AADs ) at 1 year . Mean age was 52 ± 10 years , 82 % were male . Paroxysmal AF was present in 76 patients ( 77 % ) , persistent AF in 23 ( 23 % ) patients . None underwent prior ablations , and failed on 1.2 ± 0.6 AADs . At 12 months , complete freedom from atrial arrhythmias without AADs in the surgical PVI group was 88 % compared with 41 % in the transcatheter PVI group ( P < 0.001 ) . Freedom from atrial arrhythmias with AADs was 91 vs. 62 % , in the surgical vs. transcatheter PVI group , respectively ( P = 0.002 ) . Complications occurred in seven ( 21 % ) surgical PVI patients , and three ( 5 % ) transcatheter PVI patients ( P = 0.015 ) . CONCLUSION In present matched study comparing a surgical with transcatheter PVI treatment strategy in symptomatic AF patients failed on AADs , but without prior ablations , a surgical PVI strategy was more effective to prevent recurrence of atrial arrhythmias , than a transcatheter PVI treatment strategy . However , complications were more frequent with surgical PVI
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 .