Early and mid-term outcomes of total thoracoscopic Box Lesion radiofrequency ablation in patients with atrial fibrillation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

KANG Zhefeng , SHI Jun ,  GUO Yingqiang

Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding?author：

GUO Yingqiang, Email: drguoyq@hotmail.com

Keywords：

Atrial fibrillation; radiofrequency ablation; total thoracoscopic surgery; minimally invasive surgery

DOI：

10.7507/1007-4848.202104044

Video：

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Objective To evaluate the early and mid-term outcomes of total thoracoscopic Box Lesion radiofrequency ablation in patients with atrial fibrillation.Methods The clinical data of 31 patients with atrial fibrillation who underwent total thoracoscopic Box Lesion radiofrequency ablation between November 2011 and March 2018 at the Department of Cardiac Surgery in our hospital were retrospectively analyzed, including 23 males and 8 females at an average age of 66.17±8.32 years. All patients did not have concomitant severe organic heart disease which required surgical intervention.Results There were 20 patients with paroxysmal atrial fibrillation, 8 with persistent atrial fibrillation, and 3 with long-standing persistent atrial fibrillation. Twenty-nine patients got the 3-year follow-up, and 2 patients were lost to the follow-up 6 months after the surgery. The procedure was successfully performed in all patients, with an average operation time of 113.00±26.00 min. There was no perioperative death or related complication. All patients were restored to sinus rhythm immediately after surgery. Five patients got atrial fibrillation during postoperative hospitalization, which reverted to sinus rhythm after electrical cardioversion. The rate of sinus rhythm maintenance was 62.9%, 55.9% and 52.4% in postoperative 1, 2 and 3 years, respectively. No patient died during the period, and no procedure-related complication was observed.Conclusion Total thoracoscopic Box Lesion radiofrequency ablation effectively shortens operation time, and reduces surgical trauma and procedure-related complications, meanwhile, ensures the surgical outcomes.

Citation： KANG Zhefeng, SHI Jun, GUO Yingqiang. Early and mid-term outcomes of total thoracoscopic Box Lesion radiofrequency ablation in patients with atrial fibrillation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2021, 28(9): 1066-1071. doi: 10.7507/1007-4848.202104044 Copy

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2.	Magnussen C, Niiranen TJ, Ojeda FM, et al. Sex differences and similarities in atrial fibrillation epidemiology, risk factors, and mortality in community cohorts: Results from the BiomarCaRE Consortium (Biomarker for Cardiovascular Risk Assessment in Europe). Circulation, 2017, 136(17): 1588-1597.
3.	Zhang S. Atrial fibrillation in mainland China: Epidemiology and current management. Heart, 2009, 95(13): 1052-1055.
4.	Cox JL, Schuessler RB, D'Agostino HJ, et al. The surgical treatment of atrial fibrillation. Ⅲ. Development of a definitive surgical procedure. J Thorac Cardiovasc Surg, 1991, 101(4): 569-583.
5.	Prasad SM, Maniar HS, Camillo CJ, et al. The Cox maze Ⅲ procedure for atrial fibrillation: Long-term efficacy in patients undergoing lone versus concomitant procedures. J Thorac Cardiovasc Surg, 2003, 126(6): 1822-1828.
6.	Badhwar V, Rankin JS, Damiano RJ, et al. The Society of Thoracic Surgeons 2017 clinical practice guidelines for the surgical treatment of atrial fibrillation. Ann Thorac Surg, 2017, 103(1): 329-341.
7.	O'Neill MD, Wright M, Knecht S, et al. Long-term follow-up of persistent atrial fibrillation ablation using termination as a procedural endpoint. Eur Heart J, 2009, 30(9): 1105-1112.
8.	Wolf RK, Schneeberger EW, Osterday R, et al. Video-assisted bilateral pulmonary vein isolation and left atrial appendage exclusion for atrial fibrillation. J Thorac Cardiovasc Surg, 2005, 130(3): 797-802.
9.	Sirak J, Jones D, Sun B, et al. Toward a definitive, totally thoracoscopic procedure for atrial fibrillation. Ann Thorac Surg, 2008, 86(6): 1960-1964.
10.	石峻, 張本貴, 白志軒, 等. 全胸腔鏡下Box Lesion雙極射頻治療心房顫動. 中國胸心血管外科臨床雜志, 2011, 18(5): 433-435.
11.	European Heart Rhythm Association, European Association for Cardio-Thoracic Surgery, Camm AJ, et al. Guidelines for the management of atrial fibrillation: The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J, 2010, 31(19): 2369-2429.
12.	Calkins H, Kuck KH, Cappato R, et al. 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: Recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design: A report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation. Developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology (ESC) and the European Cardiac Arrhythmia Society (ECAS); and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). Endorsed by the governing bodies of the American College of Cardiology Foundation, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, the Asia Pacific Heart Rhythm Society, and the Heart Rhythm Society. Heart Rhythm, 2012, 9(4): 632-696.
13.	郭秋哲, 郭應強, 石應康. 心房顫動外科治療的歷史與現狀. 心血管病學進展, 2013, 34(3): 64-67.
14.	Knecht S, Oelschl?ger C, Duning T, et al. Atrial fibrillation in stroke-free patients is associated with memory impairment and hippocampal atrophy. Eur Heart J, 2008, 29(17): 2125-2132.
15.	Liu J, Huang CX, Bao MW, et al. Ectopic activity induced by elevated atrial pressure in rabbit pulmonary vein in vitro. Chin Med J (Engl), 2005, 118(14): 1210-1213.
16.	楊延宗, 黃從新, 高連君, 等. 陣發性心房顫動大靜脈電隔離后肌袖內自發電活動的特點. 中華心律失常學雜志, 2013, 8(3): 146-150.
17.	Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace, 2018, 20(1): e1-e160.
18.	Shah D, Haissaguerre M, Jais P, et al. Nonpulmonary vein foci: Do they exist? Pacing Clin Electrophysiol, 2003, 26(7 Pt 2): 1631-1635.
19.	Kumagai K, Muraoka S, Mitsutake C, et al. A new approach for complete isolation of the posterior left atrium including pulmonary veins for atrial fibrillation. J Cardiovasc Electrophysiol, 2007, 18(10): 1047-1052.
20.	Voeller RK, Bailey MS, Zierer A, et al. Isolating the entire posterior left atrium improves surgical outcomes after the Cox maze procedure. J Thorac Cardiovasc Surg, 2008, 135(4): 870-877.
21.	Wang TKM, Liao YB, Wang MTM, et al. Catheter vs thoracoscopic ablation for atrial fibrillation: Meta-analysis of randomized trials. J Arrhythm, 2020, 36(4): 789-793.
22.	Sugihara C, Furniss S, Hyde J, et al. Results of the first investigator-initiated randomized clinical trial of nMARQTM, PVACTM, and thoracoscopic ablation for paroxysmal atrial fibrillation. Europace, 2018, 20(FI_3): f384-f391.
23.	Pokushalov E, Romanov A, Elesin D, et al. Catheter versus surgical ablation of atrial fibrillation after a failed initial pulmonary vein isolation procedure: A randomized controlled trial. J Cardiovasc Electrophysiol, 2013, 24(12): 1338-1343.
24.	黃從新, 張澍, 黃德嘉, 等. 心房顫動: 目前的認識和治療的建議-2018. 中國心臟起搏與心電生理雜志, 2018, 32(4): 6-59.
25.	劉俊, 方丕華, 劉悅, 等. 心房顫動消融術后三個月內房性心律失常發生與遠期成功率的關系. 中國心臟起搏與心電生理雜志, 2011, 25(2): 115-118.
26.	Vos LM, Bentala M, Geuzebroek GS, et al. Long-term outcome after totally thoracoscopic ablation for atrial fibrillation. J Cardiovasc Electrophysiol, 2020, 31(1): 40-45.
27.	Soni LK, Cedola SR, Cogan J, et al. Right atrial lesions do not improve the efficacy of a complete left atrial lesion set in the surgical treatment of atrial fibrillation, but they do increase procedural morbidity. J Thorac Cardiovasc Surg, 2013, 145(2): 356-361.
28.	陳建樂, 姜云, 倪布清, 等. 全胸腔鏡微創迷宮術治療孤立性房顫術后早期復發的危險因素分析. 南京醫科大學學報(自然科學版), 2018, 38(5): 688-690.

1. Benjamin EJ, Muntner P, Alonso A, et al. Heart disease and stroke statistics-2019 update: A report from the American Heart Association. Circulation, 2019, 139(10): e56-e528.
2. Magnussen C, Niiranen TJ, Ojeda FM, et al. Sex differences and similarities in atrial fibrillation epidemiology, risk factors, and mortality in community cohorts: Results from the BiomarCaRE Consortium (Biomarker for Cardiovascular Risk Assessment in Europe). Circulation, 2017, 136(17): 1588-1597.
3. Zhang S. Atrial fibrillation in mainland China: Epidemiology and current management. Heart, 2009, 95(13): 1052-1055.
4. Cox JL, Schuessler RB, D'Agostino HJ, et al. The surgical treatment of atrial fibrillation. Ⅲ. Development of a definitive surgical procedure. J Thorac Cardiovasc Surg, 1991, 101(4): 569-583.
5. Prasad SM, Maniar HS, Camillo CJ, et al. The Cox maze Ⅲ procedure for atrial fibrillation: Long-term efficacy in patients undergoing lone versus concomitant procedures. J Thorac Cardiovasc Surg, 2003, 126(6): 1822-1828.
6. Badhwar V, Rankin JS, Damiano RJ, et al. The Society of Thoracic Surgeons 2017 clinical practice guidelines for the surgical treatment of atrial fibrillation. Ann Thorac Surg, 2017, 103(1): 329-341.
7. O'Neill MD, Wright M, Knecht S, et al. Long-term follow-up of persistent atrial fibrillation ablation using termination as a procedural endpoint. Eur Heart J, 2009, 30(9): 1105-1112.
8. Wolf RK, Schneeberger EW, Osterday R, et al. Video-assisted bilateral pulmonary vein isolation and left atrial appendage exclusion for atrial fibrillation. J Thorac Cardiovasc Surg, 2005, 130(3): 797-802.
9. Sirak J, Jones D, Sun B, et al. Toward a definitive, totally thoracoscopic procedure for atrial fibrillation. Ann Thorac Surg, 2008, 86(6): 1960-1964.
10. 石峻, 張本貴, 白志軒, 等. 全胸腔鏡下Box Lesion雙極射頻治療心房顫動. 中國胸心血管外科臨床雜志, 2011, 18(5): 433-435.
11. European Heart Rhythm Association, European Association for Cardio-Thoracic Surgery, Camm AJ, et al. Guidelines for the management of atrial fibrillation: The Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC). Eur Heart J, 2010, 31(19): 2369-2429.
12. Calkins H, Kuck KH, Cappato R, et al. 2012 HRS/EHRA/ECAS expert consensus statement on catheter and surgical ablation of atrial fibrillation: Recommendations for patient selection, procedural techniques, patient management and follow-up, definitions, endpoints, and research trial design: A report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation. Developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology (ESC) and the European Cardiac Arrhythmia Society (ECAS); and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). Endorsed by the governing bodies of the American College of Cardiology Foundation, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, the Asia Pacific Heart Rhythm Society, and the Heart Rhythm Society. Heart Rhythm, 2012, 9(4): 632-696.
13. 郭秋哲, 郭應強, 石應康. 心房顫動外科治療的歷史與現狀. 心血管病學進展, 2013, 34(3): 64-67.
14. Knecht S, Oelschl?ger C, Duning T, et al. Atrial fibrillation in stroke-free patients is associated with memory impairment and hippocampal atrophy. Eur Heart J, 2008, 29(17): 2125-2132.
15. Liu J, Huang CX, Bao MW, et al. Ectopic activity induced by elevated atrial pressure in rabbit pulmonary vein in vitro. Chin Med J (Engl), 2005, 118(14): 1210-1213.
16. 楊延宗, 黃從新, 高連君, 等. 陣發性心房顫動大靜脈電隔離后肌袖內自發電活動的特點. 中華心律失常學雜志, 2013, 8(3): 146-150.
17. Calkins H, Hindricks G, Cappato R, et al. 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace, 2018, 20(1): e1-e160.
18. Shah D, Haissaguerre M, Jais P, et al. Nonpulmonary vein foci: Do they exist? Pacing Clin Electrophysiol, 2003, 26(7 Pt 2): 1631-1635.
19. Kumagai K, Muraoka S, Mitsutake C, et al. A new approach for complete isolation of the posterior left atrium including pulmonary veins for atrial fibrillation. J Cardiovasc Electrophysiol, 2007, 18(10): 1047-1052.
20. Voeller RK, Bailey MS, Zierer A, et al. Isolating the entire posterior left atrium improves surgical outcomes after the Cox maze procedure. J Thorac Cardiovasc Surg, 2008, 135(4): 870-877.
21. Wang TKM, Liao YB, Wang MTM, et al. Catheter vs thoracoscopic ablation for atrial fibrillation: Meta-analysis of randomized trials. J Arrhythm, 2020, 36(4): 789-793.
22. Sugihara C, Furniss S, Hyde J, et al. Results of the first investigator-initiated randomized clinical trial of nMARQTM, PVACTM, and thoracoscopic ablation for paroxysmal atrial fibrillation. Europace, 2018, 20(FI_3): f384-f391.
23. Pokushalov E, Romanov A, Elesin D, et al. Catheter versus surgical ablation of atrial fibrillation after a failed initial pulmonary vein isolation procedure: A randomized controlled trial. J Cardiovasc Electrophysiol, 2013, 24(12): 1338-1343.
24. 黃從新, 張澍, 黃德嘉, 等. 心房顫動: 目前的認識和治療的建議-2018. 中國心臟起搏與心電生理雜志, 2018, 32(4): 6-59.
25. 劉俊, 方丕華, 劉悅, 等. 心房顫動消融術后三個月內房性心律失常發生與遠期成功率的關系. 中國心臟起搏與心電生理雜志, 2011, 25(2): 115-118.
26. Vos LM, Bentala M, Geuzebroek GS, et al. Long-term outcome after totally thoracoscopic ablation for atrial fibrillation. J Cardiovasc Electrophysiol, 2020, 31(1): 40-45.
27. Soni LK, Cedola SR, Cogan J, et al. Right atrial lesions do not improve the efficacy of a complete left atrial lesion set in the surgical treatment of atrial fibrillation, but they do increase procedural morbidity. J Thorac Cardiovasc Surg, 2013, 145(2): 356-361.
28. 陳建樂, 姜云, 倪布清, 等. 全胸腔鏡微創迷宮術治療孤立性房顫術后早期復發的危險因素分析. 南京醫科大學學報(自然科學版), 2018, 38(5): 688-690.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Early and mid-term outcomes of total thoracoscopic Box Lesion radiofrequency ablation in patients with atrial fibrillation

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