MINIMALLY INVASIVE THORACOSCOPIC HYBRID TREATMENTOF LONE ATRIAL FIBRILLATION: EARLY RESULTS OF MONOPOLAR VERSUS BIPOLAR RADIOFREQUENCY SOURCE
C. Puntrello (a), F. Lucà (a), M. La Meir (b), G.F. Gensini (c), L. Pison (d), F. Wellens (d), J. Maessen (d),
S. Gelsomino (c)
(a) Department of Cardiology, Paolo Borsellino Hospital, Marsala, Trapani, Italy; (b)Department of Cardiac Surgery, University Hospital, Brussels, Belgium;
(c) Department of Heart and Vessels, Careggi Hospital, Florence, Italy;
(d) Department of Department of Cardiology and Cardiothoracic Surgery, University Hospital, Maastricht, The Netherlands
Introduction: We compare results of a hybrid monopolar vs. a hybrid bipolar thoracoscopic approach employing radiofrequency (RF) sources for the surgical treatment of lone atrial fibrillation (LAF).
Methods: From January 2008 to June 2010, 19 patients (35.1%) underwent RF monopolar/monolateral RF ablation, whereas 35 (64.9%) had RF bipolar/bilateral thoracoscopic ablation. One-year time-related prevalence of postoperative AF was 13.3 (11.0–17.4) and 5.2% (4.2–6.7), in monopolar and bipolar groups, respectively (P < 0.001). It was 21.1 (17.6–24.9) vs. 8.2% (5.1–11.6) in long standing persistent (P < 0.001), 13.2 (10.6–17.8) vs. 3.8% (1.4–6.9) in persistent (P < 0.001) and 5.6 (2.8–8.3) vs. 3.2% (1.0–6.5) in paroxysmal AF (P = 0.64). At 12 months, estimated prevalence of anti-arrhythmic drugs was 26 (22.4–30.1) and 18.0% (15.5–21.7, P = 0.04), whereas prevalence of Warfarin use was 48.2 (44.2–52.2) and 29.0% (26.2–33.1, P < 0.001) in the monopolar and bipolar groups, respectively. Left atrial (LA) reverse remodelling occurred in 47.3% of monopolar patients (n = 9) and in 77.1% of bipolar patients (P = 0.03).
Results: The hybrid bilateral approach with a bipolar device for the treatment of LAF showed a good 1-year success rate independently of the AF type and seems to be the better choice for longstanding persistent and persistent LAF.
