A Totally Endoscopic, Beating-Heart Approach to Pulmonary Vein Isolation for the Treatment of Atrial Fibrillation

Michael Argenziano, Mauricio Garrido, Mathew R.Williams, L.Wiley Nifong, Craig R. Smith, Mehmet C. Oz

Columbia University College of Physicians & Surgeons NY,NY, USA,
East Carolina University School of Medicine Greenville,NC, USA

OBJECTIVE: Recent studies suggest that atrial fibrillation (AF) may be triggered by discrete foci located within the pulmonary veins, and that this arrhythmia may be eliminated by electrically isolating the pulmonary veins (PV).We have previously reported a minimally invasive technique of PV isolation, using a novel microwave energy source through a minithoracotomy.This report describes a totally endoscopic, beating heart operation for AF, using robotic assistance.

METHODS: Pulmonary vein isolation and resection of the left atrial appendage (LAA) was performed in 6 dogs. The surgical approach utilized a 3 left and 3 right thoracoscopy ports, using robotic assistance (DaVinci, Intuitive Surgical, Inc.). All pulmonary veins were encircled and electrically isolated by one contiguous myocardial lesion created by the epicardial application of microwave energy at 75 Watts for 120 seconds (Flex-10 probe, AFx, Inc.). The left atrial appendage was resected with a standard thoracoscopic stapling device.

RESULTS: In all cases, the cardiac dissection required for exposure of the left atrium, as well as accurate probe positioning, was effected completely endoscopically. There were no bleeding complications, and the Flex-10 probe effected atrial ablation without collateral cardiac damage.

CONCLUSIONS: Electrical isolation of the pulmonary veins and resection of the left atrial appendage can be effected via a minimally invasive, beating heart approach, utilizing robotic techniques and a novel microwave energy source