Mid-Term Performance of Bipolar Radiofrequency Ablation for Isolated Atrial Fibrillation Through a Right Minithoracotomy

Catheter ablation is considered the first-line treatment for drug-refractory atrial fibrillation (AF). Minimally invasive epicardial pulmonary veins isolation may provide durable freedom from recurrent arrhythmia. However, evidence come from small studies. Aim of this study is to assess early- and mid-term performance of surgical bipolar ablation of AF through right minithoracotomy in a large cohort of patients. From September 2012 till September 2015, 126 consecutive patients with drug-refractory isolated AF, equally suitable for both surgical or catheter ablation, underwent bipolar minimally invasive surgical isolation of the pulmonary veins through right 3- to 4-cm minithoracotomy at our institution, and they were followed up for a median of 23.5 months (interquartile range = 20). There was a relatively low rate of postoperative complication with no perioperative death. One patient died at follow-up. The shape of the time-varying probability of AF was calculated, with 3 peaks approximately 6, 12, and 24 months after procedures. Three patients were lost at last follow-up; thus, it was 97.6% completed. Overall freedom from recurrent arrhythmia was 78.8%. However, freedom from antiarrhythmic drugs was very low because of gap in medication management. Quantitative but not qualitative measure of health outcome significantly improved at follow-up (P < 0.001). Bipolar radiofrequency ablation via right minithoracotomy was a safe procedure with acceptable early outcomes; however, mid-term results should be interpreted in a context of a very low freedom from antiarrhythmic drugs.