Additional cavotricuspid isthmus ablation may reduce recurrent atrial tachyarrhythmia after total thoracoscopic ablation for persistent atrial fibrillation†

OBJECTIVES: Unlike catheter ablation, little is known about the benefits of cavotricuspid isthmus (CTI) ablation in total thoracoscopic ablation (TTA) of atrial fibrillation (AF). This study aimed to investigate the incidence of recurrent atrial tachyarrhythmia (ATa) according to additional CTI ablation after TTA in patients with persistent AF. METHODS: Among 208 consecutive patients who underwent TTA for persistent AF at the Samsung Medical Center from February 2012 to January 2016, a total of 63 patients with CTI ablation and 91 patients without CTI ablation were included in the final analysis. CTI ablation was performed in patients who had long-standing AF or atrial flutter episodes during the admission period. RESULTS: There was no difference in baseline characteristics between the CTI ablation and non-CTI ablation groups, except for a higher number of male patients in the CTI ablation group. The CTI ablation group showed a significantly higher survival rate free from recurrent ATa than that of the non-CTI ablation group at 5 years (52.5% vs 41.4%, P = 0.046). In the multivariable analysis, CTI ablation (hazard ratio 0.46, 95% confidence interval 0.217–0.971; P = 0.042) and left atrial volume index (hazard ratio 1.05, 95% confidence interval 1.029–1.070; P < 0.001) were significantly correlated with recurrent ATa. CONCLUSIONS: Patients with CTI ablation showed a better survival rate free from recurrent ATa compared with the non-CTI ablation group. The additional CTI ablation may reduce recurrent ATa after TTA in patients with documented atrial flutter or long-standing AF.