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 .
Pulmonary vein isolation and autonomic denervation for the management of paroxysmal atrial fibrillation by a minimally invasive surgical approach.
BACKGROUND Advances in technology such as epicardial bipolar radiofrequency pulmonary vein isolation , ganglionated plexi identification , and isolation and thoracoscopic left atrial appendage exclusion have enabled less invasive surgical options for management of atrial fibrillation . METHODS We performed a prospect i ve , nonr and omized study of consecutive patients with symptomatic paroxysmal atrial fibrillation undergoing a video-assisted , minimally invasive surgical ablation procedure .  The procedure consisted of bilateral , epicardial pulmonary vein isolation with bipolar radiofrequency , partial autonomic denervation , and selective excision of the left atrial appendage . Minimum follow-up was 1 year with long-term monitoring ( 24-hour continuous , 14-day event or pacemaker interrogation ) . RESULTS Between March 2005 and January 2008 , 52 patients ( 35 male ) , mean age 60.3 years ( range , 42 - 79 years ) underwent the procedure . The left atrial appendage was isolated in 88.0 % ( 44/50 ) . Average hospital stay was 5.2 days ( range 3 - 10 days ) . There were no operative deaths or major adverse cardiac events . On long-term monitoring , freedom from atrial fibrillation/flutter/tachycardia was 86.3 % ( 44/51 ) and 80.8 % ( 42/52 ) at 6 and 12 months , respectively . Antiarrhythmic drugs were stopped in 33 of 37 patients and warfarin in 30 of 37 of the patients in whom ablation was successful at 12 months . Freedom from symptoms attributed to atrial fibrillation/flutter/tachycardia was 78.0 % ( 39/50 ) at 6 months and 63.8 % ( 30/47 ) at 12 months . CONCLUSIONS Minimally invasive surgical ablation is effective in the management of paroxysmal atrial fibrillation as evidence d by freedom from atrial arrythmias by long-term monitoring at 12 months . Measuring success using clinical symptoms underestimated clinical success as compared with long-term monitoring
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 .