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Thoracoscopic epicardial radiofrequency ablation for atrial fibrillation: commentary
  1. A M Gillinov,
  2. T Mihaljevic
  1. Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic, Cleveland, Ohio, USA
  1. Dr A M Gillinov, Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic/J4-1, 9500 Euclid Avenue, Cleveland, OH 44195, USA; gillinom{at}ccf.org

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Thoracoscopic epicardial radiofrequency ablation for atrial fibrillation (AF) is a new, minimally invasive surgical approach to treating AF. Because this procedure was developed only recently, there are few data documenting results of this new treatment. The National Institute for Health and Clinical Excellence has provided a guidance document concerning thoracoscopic epicardial radiofrequency ablation for AF. The key components of this document include (a) indications and current treatments; (b) an outline of the procedure; (c) reviews of efficacy and safety; (d) guidance about appropriate application of the procedure.

INDICATIONS AND CURRENT TREATMENTS

AF is the most common arrhythmia, affecting millions of people world wide. The combination of an ageing global population and the increased prevalence of AF in the elderly has set the stage for a dramatic increase in the number of people diagnosed with AF over the next two to three decades. While AF is well-tolerated by many, it is not innocuous. Patients with AF may have uncomfortable symptoms as a consequence of the tachycardia and are at risk for stroke, tachycardia-induced cardiomyopathy and complications of medical treatment. Therefore, there is great interest in the development of interventional treatments designed to treat AF. We have consciously chosen not to use the word “cure” here because this term implies that AF will never recur after treatment. To date, we are not aware of any treatments that have been proved to cure AF.

Today, most people with AF are treated medically with either a strategy of attempted rhythm control or a strategy of rate control with anticoagulation. Most patients treated in this way achieve acceptable control of symptoms and enjoy high freedom from thromboembolism; these approaches are reasonably successful. When a patient for whom medical treatment has failed, …

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