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Usefulness of Postprocedural Electrophysiological Confirmation Upon Totally Thoracoscopic Ablation in Persistent Atrial Fibrillation

  • Author Footnotes
    1 Min Suk Choi and Young Keun On, these authors contributed equally to this work as co-first authors.
    Min Suk Choi
    Footnotes
    1 Min Suk Choi and Young Keun On, these authors contributed equally to this work as co-first authors.
    Affiliations
    Department of Thoracic and Cardiovascular Surgery, Dongguk University Ilsan Hospital, Dongguk University School of Medicine, Goyang, Gyeonggi, South Korea
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  • Author Footnotes
    1 Min Suk Choi and Young Keun On, these authors contributed equally to this work as co-first authors.
    Young Keun On
    Footnotes
    1 Min Suk Choi and Young Keun On, these authors contributed equally to this work as co-first authors.
    Affiliations
    Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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  • Dong Seop Jeong
    Correspondence
    Corresponding author: Tel: +82-2-3410-3489; fax: 82-2-3410-0089.
    Affiliations
    Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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  • Kyoung-Min Park
    Affiliations
    Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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  • Seung-Jung Park
    Affiliations
    Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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  • June Soo Kim
    Affiliations
    Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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  • Keumhee C. Carriere
    Affiliations
    Biostatistics and Clinical Epidemiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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  • Author Footnotes
    1 Min Suk Choi and Young Keun On, these authors contributed equally to this work as co-first authors.
Published:January 07, 2020DOI:https://doi.org/10.1016/j.amjcard.2019.12.046
      Little information is available concerning the usefulness of electrophysiological confirmation followed by totally thoracoscopic ablation. This study aimed to examine whether postprocedural electrophysiological confirmation is always necessary after totally thoracoscopic ablation (TTA) in patients with isolated persistent atrial fibrillation. Forty-five patients with isolated persistent atrial fibrillation were randomized into 2 groups those who received routine electrophysiological confirmation and additional catheter ablation after totally thoracoscopic ablation (the hybrid group [n = 22]) and those who did not (the TTA group [n = 23]). Electrophysiological study was performed 4 or 5 days after surgery. No early or late mortality occurred. In the hybrid group, 5 patients (23%, 5/22) required additional ablation due to residual potential in the left atrium. At a year postoperatively, normal sinus rhythm was observed in 89% of patients (40/45) and similar in both groups (Odds ratio 0.80, 95% confidence interval 0.32 to 1.99). During follow-up, sinus rhythm was maintained in 16 patients (70%) in the TTA group without additional catheter ablation, which was similar (p = 0.920) to the results in the hybrid group (n = 15, 68.2%). Event-free survival rate at 12 months did not differ between groups (TTA group vs hybrid group, 78% vs 77%; p = 0.633). In simple Cox regression analysis, preoperative left atrium volume index was associated with atrial arrhythmia (p = 0.030, hazards ratio 1.087, 95% confidence interval 1.01–1.18). In conclusion, thoracoscopic ablation provided good 1-year durability in patients with isolated persistent AF irrespective of postprocedural electrophysiological confirmation. Seventy-percent of the TTA group did not need additional catheter ablation.
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