Abstracto

Surgical ablation of atrial fibrillation and left atrial appendage occlusion by a totally videothoracoscopic approach

Rui Pedro Soares Cerejo

Atrial Fibrillation (AF) is the most common cardiacarrhythmia, and its prevalence is increasing worldwide. It remains one of the major causes of stroke, heart failure, sudden death, and cardiovascular morbidity. Pharmacological and catheter therapies are unsatisfactory and with serious adverse effects. Surgical ablation is probably the most effective treatment, with some of the best long term results even in the most “difficult“ types of AF. Cox-Maze III/IV, has the highest rates of success, but, had not been widely adopted because of complexity and low reproducibility. For symptomatic stand-alone AF, catheter therapies are usually the first-line of treatment and surgery is forgotten, even when all treatment fails. A full medium sternotomy is associated with important morbidity, but currently minimally invasive surgical options are available. With a thoracoscopic aproach it is possible to perform pulmonary veins isolation, posterior left atrium box creation and at the same procedure to close the left atrial appendage. Success at 1 year with this technique to maintain sinus rhythm varies between 75-90%. Recent international guidelines advocate it for patients with symptomatic AF, be it as first-line treatment (persistent AF) or second-line procedure (paroxysmal AF). Surgical ablation of atrial fibrillation and left atrial appendage occlusion by a totally videothoracoscopic approach represents a real benefit for those with multiple attempts of catheter ablation without success. It is a reproducible technique and it has a fast learning curve with promising results. It may represent a paradigm shift but it our patients will demand it.