Minimally invasive pulmonary vein isolation and partial autonomic denervation for surgical treatment of atrial fibrillation.

BACKGROUND: We seek to demonstrate the rationale and efficacy of a minimally invasive surgical approach to the treatment of atrial fibrillation (AF) that combines pulmonary vein antral isolation with targeted partial autonomic denervation.

METHODS: The literature supporting the rationale of this approach is reviewed. Seventy-four patients underwent video-assisted bilateral pulmonary vein antral isolation with confirmation of block and partial autonomic denervation with follow-up of 6 months or greater and have a long-term rhythm monitor at 6 months.

RESULTS: Success was defined as no episodes greater than 15 seconds of AF on long-term monitoring. Treatment was successful in 83.7% of patients with paroxysmal AF and 56.5% of patients with persistent/long-standing persistent AF.

CONCLUSIONS: There are evidence-based data that support both pulmonary vein electrical isolation and targeted partial autonomic denervation in the treatment of AF. These techniques can be combined in a minimally invasive surgical approach. Early data suggest this is a safe and efficacious approach for the treatment of paroxysmal AF. Techniques are being developed for the minimally invasive surgical treatment of persistent AF from an epicardial approach.