The completely endoscopic treatment of atrial fibrillation: report on the first 14 patients with early results.

UNLABELLED We report the early results of a new completely endoscopic technique for the treatment of atrial fibrillation (AF). METHODS Fourteen patients underwent surgery solely for the treatment of AF. The thoracoscopic technique delivered microwave energy to the epicardial surface of the beating heart. Access was obtained through 3 right-sided and 3 left-sided thoracic ports. The AFx/Guidant Flex-10 catheter was employed to produce a box lesion around the pulmonary veins along with additional right- and left-sided lesions. The left atrial appendage was amputated. RESULTS Ten patients had paroxysmal fibrillation, 1 had persistent fibrillation, and 3 were in permanent AF. Mean age of the group was 60 years, and their mean duration of AF was 74 months. Half had undergone unsuccessful attempts at chemical and/or electrical cardioversion. There were no deaths. Two patients required conversion to open procedure to control bleeding from the left atrial appendage. Average procedure time was 221 minutes, with the last 2 procedures taking less than 2 hours. Median length of hospital stay was 6 days, with 7 patients staying less than 3 days. Seventy-one percent of patients were in sinus rhythm at discharge, 100% at 6 months follow-up, and 67% at 12 months. CONCLUSION Totally endoscopic microwave ablation of atrial fibrillation appears to be safe and truly minimally invasive. It is associated with a short length of stay, short procedure time, and acceptable rhythm results. This procedure has the potential to greatly expand the indications for surgery in patients suffering from AF and deserves longer-term investigation.