En Bloc Left Pulmonary Vein and Appendage Isolation in Thoracoscopic Surgery for Atrial Fibrillation

We evaluated the safety and rhythm control effectiveness in en bloc isolation of the left pulmonary vein (PV) and appendage conducted as part of the thoracoscopic procedure for bilateral PV isolation, non-PV ablation, and appendage closure for atrial fibrillation (AF). Procedural safety was evaluated by reviewing the surgical records. Rhythm control was examined in accordance with the Heart Rhythm Society guidelines at postoperative months 1, 3, 6, and 12, and yearly thereafter. The sinus rhythm rates at postoperative years 1 and 2 were compared with the corresponding data from our previous procedure without the en bloc technique. Starting in 2014, the en bloc technique was applied to 238 nonvalvular AF patients and successfully performed in all but 23 patients. The mean operation time was 88 minutes. There were no hospital deaths or major procedure-related complications. The mean follow-up period was 1.7 years. The sinus rhythm rates at postoperative years 1 and 2 were 85% and 80% in paroxysmal, 76% and 70% in persistent, and 67% and 61% in long-standing persistent AF, respectively, without antiarrhythmic drug use. Compared with the previous procedure (n = 324), sinus rhythm rates were higher in long-standing persistent AF (67% vs 50% at 1 year and 61% vs 40% at 2 years; p = 0.04). No patients suffered cardiogenic thromboembolisms without anticoagulation. Thoracoscopic en bloc left PV and appendage isolation was safely achieved in most patients. Using this technique may contribute to better rhythm control results than not using it in cases of long-standing persistent AF.