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Surgical Minimally Invasive Pulmonary Vein Isolation for Lone Atrial Fibrillation: Midterm Results of a Multicenter Study

De Maat, Gijs E. BSc*†; Pozzoli, Alberto MD*‡; Scholten, Marcoen F. MD, PhD§; Hillege, Hans L. MD, PhD; Van Gelder, Isabelle C. MD, PhD; Alfieri, Ottavio R. MD, PhD; Benussi, Stefano MD; Mariani, Massimo A. MD, PhD*

Innovations:Technology and Techniques in Cardiothoracic and Vascular Surgery: November/December 2013 - Volume 8 - Issue 6 - p 410–415
doi: 10.1097/IMI.0000000000000029
Original Articles

Objective Minimally invasive surgical pulmonary vein isolation (SMI-PVI) is an emerging therapy for the treatment of symptomatic drug-refractory atrial fibrillation (AF). Nevertheless, the midterm and long-term results of SMI-PVI remain unknown. The aim of this retrospective multicenter study was to report on midterm efficacy and safety of SMI-PVI.

Methods The study design was retrospective, multicentric, and observational. From July 2005 to November 2011, a total of 86 patients with drug-refractory paroxysmal or persistent AF underwent SMI-PVI in three centers. Patients were eligible for SMI-PVI if they had symptomatic, drug-refractory AF or after failed transcatheter pulmonary vein isolation. Success was defined as absence of AF on 24- or 96-hour Holter monitoring during follow-up, in the absence of antiarrhythmic drugs (AADs).

Results The mean ± SD age was 54 ± 11 years, and 78% were men. The median AF duration was 30 months (range, 2-203); paroxysmal AF was present in 86% of the patients, persistent in 14%. Fifteen patients (17%) underwent previous transcatheter ablations. After a median follow-up of 24 months (range, 6-78), 72% of all patients were free from atrial arrhythmias without the use of AADs. With AADs, this was 83%. Major perioperative adverse events occurred in 7 patients (8%).

Conclusions This retrospective multicenter study shows that SMI-PVI is effective at a median follow-up of 24 months for the treatment of mostly paroxysmal drug-refractory AF. Perioperative adverse events do remain a point of caution.

From the *Department of Cardio-Thoracic Surgery, and †Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; ‡Cardiac Surgery Unit, San Raffaele Scientific Institute, Milan, Italy; §Department of Cardiology, Medisch Spectrum Twente, Enschede, The Netherlands; and ∥Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Accepted for publication September 28, 2013.

Gijs E. De Maat, BSc, and Alberto Pozzoli, MD, contributed equally to this study and should be considered co–first authors.

Disclosures: Stefano Benussi, MD, is a consultant for AtriCure, Cincinnati, OH USA; St. Jude Medical Inc, St Paul, MN USA; Medtronic Inc, Minneapolis, MN USA; Medtronic CryoCath LP, Pointe-Claire, QC Canada; and Edwards Lifesciences Corp, Irvine, CA USA. Gijs E. De Maat, BSc; Alberto Pozzoli, MD; Marcoen F. Scholten, MD, PhD; Hans L. Hillege, MD, PhD; Isabelle C. Van Gelder, MD, PhD; Ottavio R. Alfieri, MD, PhD; and Massimo A. Mariani, MD, PhD, declare no conflicts of interest.

Address correspondence and reprint requests to Massimo A. Mariani, MD, PhD, Department of Cardio-Thoracic Surgery, Thoraxcenter, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands. E-mail:

©2013 by the International Society for Minimally Invasive Cardiothoracic Surgery