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Minimally invasive off-pump video-assisted endoscopic surgical pulmonary vein isolation using bipolar radiofrequency ablation - preliminary report.

BACKGROUND
Atrial fibrillation (AF) is the most common arrhythmia, having a strong impact on long-term stroke and heart failure prevalence and mortality. Nowadays, rapid development in the field of minimising the invasiveness of surgical ablation of AF can be observed.


AIM
To report on the feasibility and early results of the first Polish experience with a novel technique of minimally invasive video-assisted beating heart bilateral surgical ablation for lone paroxysmal AF using irrigated bipolar radiofrequency technique.


METHODS
Between February and December 2006, 6 patients with highly symptomatic paroxysmal AF, resistant to pharmacological treatment, underwent video-assisted beating heart bilateral pulmonary vein isolation using irrigated bipolar radiofrequency combined with vein of Marshall dissection and left atrial appendage closure. In 2 patients at least 2 unsuccessful percutaenous ablations had previously been performed.


RESULTS
There were no complications. Ablation time was on average 88+/-12.1 seconds. At least one recurrence of AF was observed in 4 patients in the early postoperative period; in 3 of them an electrical cardioversion was performed. All patients were discharged home in stable sinus rhythm. Three patients have exceeded 3 months' observation; one has reached 6 months of observation. All are in stable sinus rhythm and the follow-up course is uneventful.


CONCLUSIONS
Minimally invasive video-assisted beating heart bilateral surgical ablation for lone paroxysmal AF using irrigated bipolar radiofrequency is effective and safe. These promising results have to be confirmed by larger studies.