RT Journal Article
SR Electronic
T1 28 Do the risks and benefits of thoracoscopic af ablation justify its endorsement in guidelines? a propensity matched study with catheter ablation
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP A26
OP A27
DO 10.1136/heartjnl-2018-BCS.28
VO 104
IS Suppl 6
A1 Charles Pearman
A1 James Redfern
A1 Emmanuel Williams
A1 Simon Modi
A1 Mathew Shaw
A1 Rebecca King
A1 Mark Hall
A1 Johan Waktare
A1 Saagar Mahida
A1 Derick Todd
A1 Richard Snowdon
A1 Neeraj Mediratta
A1 Dhiraj Gupta
YR 2018
UL http://heart.bmj.com/content/104/Suppl_6/A26.abstract
AB Introduction The safety and efficacy of Standalone video assisted thoracoscopic surgical (VATS) ablation for atrial fibrillation (AF) has not been established. In particular, comparative data with catheter ablation (CA) are scarce.Methods We prospectively collected data on 30 consecutive VATS AF ablations (mean age 58±10 years, 26 male) performed by an a single surgeon, the first 20 of which were proctored by external surgeons. We compared peri-procedural complications and medium-term arrhythmia free survival to those of 90 propensity-matched patients who underwent RF CA during the same time period.Results VATS and catheter patients were well matched with regard to all measured demographics (table 1). 6 (20.0%) patients undergoing VATS experienced 1 major complication (death n=1, stroke n=2, conversion to sternotomy n=3, phrenic nerve injury n=2). This was significantly higher than the 1 (1.1%) major complication rate (tamponade requiring drainage) seen with CA; p<0.001. The median hospital stay with VATS (7 days) was significantly greater than with CA (2 days), p<0.001. Over the follow up period, 12 (42.9%) and 5 (17.9%) patients in the VATS group and 16 (18.6%) and 13 (15.1%) patients in the CA group needed electrical cardioversion and repeat CA respectively (p=0.009 and p=0.13 respectively). At a mean follow up of 15.6 months, single procedure pragmatic arrhythmia-free survival was 50% in the VATS and 66% in the CA cohort, p=0.18 (figure 1).View this table:Abstract 28 Table 1Abstract 28 Figure 1Conclusions Standalone VATS AF ablation is associated with similar success rates to catheter ablation, but with a significantly higher rate of major complications.