Thoracoscopic epicardial ablation of the left and right atrium. Beating heart procedure in patients with atrial fibrillation

INTRODUCTION Atrial fibrillation (AF) is a common arrhythmia affecting approximately 1% to 2% of the general population. 
OBJECTIVES The aim of the study was to evaluate the efficacy and safety of thoracoscopic ablation in patients with AF.
PATIENTS AND METHODS A total of 25 patients aged from 42 to 77 years (mean 56.4 years) with persistent or long‑standing persistent AF were scheduled for the procedure. Thoracoscopic epicardial ablation of the right atrium, pulmonary veins, and left atrium was performed on the beating heart using the Cox MAZE III‑based diagram, via 3 ports and 2 cm incision below the xiphoid. Exit block was always assessed. Patients were prospectively followed for 12 months after the procedure. 24‑hour electrocardiography (Holter monitoring) was used to confirm the results. 
RESULTS Conduction block across ablation lines was achieved in 21 patients (84%). At 1 month of follow‑up, the sinus rhythm (SR) was observed in 18 of 20 patients. At 3 months, the SR was observed in 19 patients (76%). Two patients had atrial flutter, while 3 still experienced AF. At 6 months, the SR was observed in 21 patients (84%); 2 patients still had AF, 1 patient atrial flutter, and 1 patient had a pacemaker implanted. Results of follow‑up at 1 year did not differ from those at 6 months. No changes in the size of the left atrium and left ventricular ejection fraction, no deaths, stroke, transient ischemic attack, or infectious complications were observed. 
CONCLUSIONS The efficacy of epicardial thoracoscopic ablation of the left and right atrium was high, reaching 84% during 1‑year follow‑up. No serious complications were observed in the postoperative period (except for the need for pacemaker implantation in 1 patient).