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Promising Mid-Term Results From Thoracoscopic Ablation of Persistent Atrial Fibrillation Presented at Meeting of International Society for Minimally Invasive Cardiothoracic Surgery
Patients show three-year freedom from atrial fibrillation, anti-arrhythmic drugs
Afib is an irregular heartbeat that affects up to 2 percent of the population worldwide. The risk of stroke is five times greater in patients suffering from this disease. Afib is responsible for 15-20 percent of all strokes and is associated with increased mortality, morbidity and a reduced quality of life.
Catheter ablation is a common treatment in patients with symptomatic Afib not responding to medications. However, mid-term results of more chronic forms of Afib even after repeat catheter ablation have been marginal. Surgical ablation is a promising, single procedure alternative being researched in advanced heart centers like Sana Heart Center.
“Catheter ablation is quite effective in less severe forms of Afib, but
chronic Afib demands a more intensive approach in terms of making robust
scars on the heart to thoroughly interrupt the electrical signals that
cause the problem. We have demonstrated that this minimally invasive
approach yields superior results in these challenging forms of Afib,”
From 2009 to 2013 Stuttgart group enrolled 121 patients in the study, 25 percent of whom had failed at least two previous catheter ablation procedures. The objective of the study was to evaluate the efficacy of an endoscopic approach in performing a left atrial lesion set on the beating heart. Radiofrequency ablation was performed via a bilateral endoscopic ablation approach using small ports and a microscopic camera for visualization. Post procedure heart rhythms were evaluated using sophisticated monitoring protocols at 6, 12, 24 and 36 months to determine procedural success.
During the study, there were no deaths, no conversions to sternotomy and no early or late strokes. The data showed that 80 percent of patients were free from Afib three years after their procedures, and 80 percent were free from both Afib and anti-arrhythmic drugs three years after surgery. Quality of life improvements were shown to increase significantly from preoperative assessments.
“This new thoracoscopic approach to treat chronic Afib is a big step toward a less invasive treatment with excellent clinical and cosmetic results. We believe that working in collaboration with our electrophysiologists that the results can be improved further. However randomized trials are necessary to establish this approach as a standard of care,” said Dr. Doll.
For details on this study, please see ISMICS website http://meetings.ismics.org/abstracts/2013/C9.cgi.
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