A Video-Assisted Thoracoscopic Technique to Encircle the Four Pulmonary Veins: A New Surgical Intervention for Atrial Fibrillation Ablation

(#2002-01889 ... April 26, 2002)

Eric Manasse, MD,¹ Maurizio Infante, MD,² Simone Ghiselli, MD,¹ Umberto Cariboni, MD,² Marco Alloisio, MD,² Alessandro Barbone, MD,¹ Alessandro Addis, MD,³ Roberto Gallotti, MD¹

Departments of ¹Cardiac Surgery and ²Thoracic Surgery, Istituto Clinico Humanitas; ³Istituto di Clinica Chirurgica Veterinaria, Universita degli Studi di Milano, Milan, Italy

Abstract:

Background: Atrial fibrillation (AF) is the most common of the so-called benign arrhythmias. It affects not only life expectancy but also quality of life. Until recently, surgeons have most often encountered AF in association with ischemic or valvular disease but rarely as lone atrial fibrillation (LAF). For the subset of LAF patients, a minimally invasive procedure is recommended.

Methods: Using an animal model, we have developed a video-assisted thoracoscopic approach to atrial ablation whereby the ablation is performed encircling the four pulmonary veins as through a median sternotomy.

Results: Fifteen animals were used, and in 5 a complete encircling of the pulmonary veins was accomplished using the thoracoscopic approach.

Discussion: Video-assisted thoracoscopy is a feasible and safe approach for epicardial pulmonary vein ablation. This technique offers the option of surgery to a class of patients who are resistant to medical therapy but for whom the presence of LAF contraindicates the open chest approach.

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