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Thoracoscopic left atrial ablation in patients with nonparoxysmal atrial fibrillation: immediate and midterm results

Authors: Bystrov D.O.1, Komarov R.N.2, Shonbin A.N.1, Afonin B.O.1, Sorokin R.O.1, Matsuganov D.A.2

Company: 1 First City Clinical Hospital named after I.I. Volosevich, Arkhangelsk, Russian Federation
2 I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation

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Type:  Original articles


DOI: https://doi.org/10.24022/1997-3187-2024-18-3-341-349

For citation: Bystrov D.O., Komarov R.N., Shonbin A.N., Afonin B.O., Sorokin R.O., Matsuganov D.A. Thoracoscopic left atrial ablation in patients with nonparoxysmal atrial fibrillation: immediate and midterm results. Creative Cardiology. 2024; 18 (3): 341–349 (in Russ.). DOI: 10.24022/1997-3187-2024-18-3-341-349

Received / Accepted:  16.05.2024 / 05.07.2024

Keywords: atrial fibrillation Maze thoracoscopic epicardial ablation minimally invasive cardiac surgery



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Abstract

Objective. To evaluate the long-term results of thoracoscopic radiofrequency ablation (T-RFA) of the left atrium (LA) in patients with nonparoxysmal atrial fibrillation (AF).

Material and methods. The study included 32 patients with nonparoxysmal AF who underwent thoracoscopic radiofrequency ablation of the left atrium from January 2018 to December 2021. Long-term results were evaluated after 3, 6, 12, 24, 36 months. The criterion for the effectiveness of T-RFA LA surgery was the absence of tachyarrhythmia lasting more than 30 seconds, confirmed by 24-hour Holter monitoring. Major cardiac, cerebral events and mortality in the long- term period were analyzed. The quality of life was also assessed using the SF-36 online questionnaire.

Results. All patients were discharged with sinus rhythm. The complicated postoperative period was observed in 3 (9.4%) patients. 2 patients developed a stroke on the 3rd and 5th days with a preserved sinus rhythm and had a hemothorax, which required thoracoscopic revision. There were no fatal cases. In the long-term period (36 months), 1 fatal outcome was noted on 63 days after surgery. During the follow-up, 2 patients developed a stroke on the background of sinus rhythm. Sinus rhythm was observed after 36 months in 23 (74.2%) out of 31 patients. Atypical atrial flutter was registered in 5 (16.1%) patients and typical atrial flutter was registered in 3 (9.7%) patients. Among 23 patients with sinus rhythm after thoracoscopic ablation, 7 (30.4%) received antiarrhythmic therapy. After 12 and 24 months, significant improvements of quality of life was registered.

Conclusion. Thoracoscopic epicardial radiofrequency ablation of the left atrium is accompanied by a low level of complications and mortality, good immediate and satisfactory long-term results, which makes it possible to consider it an alternative to other strategies for controlling heart rhythm in nonparoxysmal forms of atrial fibrillation.

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About Authors

  • Dmitriy O. Bystrov, Cand. Med. Sci., Cardiovascular Surgeon; ORCID
  • Roman N. Komarov, Dr. Med. Sci., Professor, Director of the Clinical Center, Cardiovascular Surgeon; ORCID
  • Aleksey N. Shonbin, Cand. Med. Sci., Cardiovascular Surgeon, Head of Department; ORCID
  • Boris O. Afonin, Cardiovascular Surgeon; ORCID
  • Roman O. Sorokin, Cardiovascular Surgeon; ORCID
  • Denis A. Matsuganov, Cand. Med. Sci., Cardiovascular Surgeon; ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


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