Early experience of thoracoscopic vs. catheter ablation for atrial fibrillation

Europace. 2019 May 1;21(5):738-745. doi: 10.1093/europace/euy303.

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 = 1, stroke n = 2, conversion to sternotomy n = 3, and phrenic nerve injury n = 2). This was significantly higher than the 1.1% major complication rate (tamponade requiring drainage n = 1) seen with CA (P < 0.001). Twelve-month single procedure arrhythmia-free survival rates without antiarrhythmic drugs were 56% in the VATS and 57% in the CA cohorts (P = 0.22), and 78% and 80%, respectively given an additional CA and antiarrhythmic drugs (P = 0.32).

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.

Keywords: Atrial fibrillation; Catheter ablation; Cohort study; Complications; Minimally invasive; Surgical ablation; Thoracoscopic.

MeSH terms

  • Atrial Fibrillation / diagnosis
  • Atrial Fibrillation / surgery*
  • Cardiac Tamponade* / epidemiology
  • Cardiac Tamponade* / etiology
  • Cardiac Tamponade* / surgery
  • Catheter Ablation* / adverse effects
  • Catheter Ablation* / methods
  • Cohort Studies
  • Comparative Effectiveness Research
  • Conversion to Open Surgery / statistics & numerical data*
  • Female
  • Humans
  • Intraoperative Complications* / epidemiology
  • Intraoperative Complications* / etiology
  • Male
  • Middle Aged
  • Outcome and Process Assessment, Health Care
  • Phrenic Nerve / injuries
  • Thoracic Surgery, Video-Assisted* / adverse effects
  • Thoracic Surgery, Video-Assisted* / methods
  • United Kingdom