Specific linear left atrial lesions in atrial fibrillation: Intraoperative radiofrequency ablation using minimally invasive surgical techniques

Objectives A specific left atrial (LA) linear lesion concept for treatment of paroxysmal and permanent atrial fibrillation (AF) was tested using intraoperative ablation with minimally invasive surgical techniques. Background Curative treatment for patients with chronic AF is among the main challenges of interventional electrophysiology. Methods Seventy patients (mean age 53 ± 10 years) with drug-refractory persistent (n = 28) or paroxysmal (n = 42) AF underwent intraoperative radiofrequency (RF) ablation using video-assisted minimally invasive techniques via a right anterolateral minithoracotomy. Contiguous lesion lines involving the mitral annulus and the orifices of the pulmonary veins were placed with RF energy application under direct vision to prevent anatomically defined LA re-entrant circuits. Results Mean follow-up was 18 ± 7 months in patients with permanent AF and 18 ± 5 months in patients with paroxysmal AF. Antiarrhythmic drug treatment was instituted in patients with postoperative atrial arrhythmias to allow “reverse electrical remodeling” and was discontinued after three months. Six months following ablation, 93% of the patients were in sinus rhythm in both groups, and after 12 months, 95% and 97%, respectively. As major complications, one esophagus perforation and one circumflex coronary artery stenosis were observed. Conclusions A pure linear lesion line concept confined to the left atrium targeting specifically at elimination of anatomically defined LA “anchor” re-entrant circuits eliminated AF in >90% of the patients treated with intraoperative ablation using minimally invasive surgical techniques over a mean follow-up of 1.5 years.