Europace | 2019
Early experience of thoracoscopic vs. catheter ablation for atrial fibrillation
Abstract
Abstract Aims Video-assisted thoracoscopic surgery (VATS) ablation has been advocated as a treatment option for non-paroxysmal atrial fibrillation (AF) in recent guidelines. Real-life data on its safety and efficacy during a centre’s early experience are sparse. Methods and results Thirty patients (28 persistent/longstanding persistent AF) underwent standalone VATS ablation for AF by an experienced thoracoscopic surgeon, with the first 20 cases proctored by external surgeons. Procedural and follow-up outcomes were collected prospectively, and compared with 90 propensity-matched patients undergoing contemporaneous catheter ablation (CA). Six (20.0%) patients undergoing VATS ablation experienced ≥1 major complication (death n\u2009=\u20091, stroke n\u2009=\u20092, conversion to sternotomy n\u2009=\u20093, and phrenic nerve injury n\u2009=\u20092). This was significantly higher than the 1.1% major complication rate (tamponade requiring drainage n\u2009=\u20091) seen with CA (P\u2009<\u20090.001). Twelve-month single procedure arrhythmia-free survival rates without antiarrhythmic drugs were 56% in the VATS and 57% in the CA cohorts (P\u2009=\u20090.22), and 78% and 80%, respectively given an additional CA and antiarrhythmic drugs (P\u2009=\u20090.32). Conclusion During a centre’s early experience, VATS ablation may have similar success rates to those from an established CA service, but carry a greater risk of major complications. Those embarking on a programme of VATS AF ablation should be aware that complication and success rates may differ from those reported by selected high-volume centres.