Long-term outcome of totally thoracoscopic surgical ablation in atrial fibrillation: A single-center experience

Background: Totally thoracoscopic ablation (TTA) is a minimally invasive and safe alternative to radiofrequency catheter ablation (RFCA) for patients with atrial fibrillation (AF). It has evolved over the last decades, but data are limited. The aim of this study was to report the long-term efficacy and safety of TTA through a single center experience. Methods: We retrospectively analyzed all consecutive patients who underwent TTA for AF from February 2012 to December 2018. All patients were followed every 3 months after operation with 12-lead ECG and 24-hour Holter ECG monitoring. The late recurrence of AF was defined as any atrial tachyarrhythmia (ATa) sustained more than 30 s from 3 months after surgery. Results: Of the total 408 patients undergoing TTA, 265 were analyzed in this study (17% paroxysmal, persistent or long standing persistent 83%, mean age 56 ± 9 years). During the mean follow-up duration 23 ± 18 months, ATa-free survival rate was 74%, 64%, 58%, 51% and 51% at 1,2,3,4 and 5 years, respectively. At the last follow-up, 75% of patients had sinus rhythm with or without additional intervention. The overall complication rate was 4.5% (12 events) and four patients (1.5%) had a stroke during follow-up. Conclusions: TTA could be effective treatment option for AF. It had a very low risk of complication and could reduce stroke incidence. Further studies are needed to improve treatment strategy.