19910 years follow-up of epicardial pulmonary isolation and vagal denervation in patients with atrial fibrillation

Abstract

Background and purpose: The minimally invasive surgery for atrial fibrillation has been adopted but the long‐term outcome of such procedure and its effects on quality of life are lacking. Methods: A total of 39 patients with symptomatic drug‐refractory atrial fibrillation, who underwent epicardial pulmonary vein isolation, ganglionated plexi ablation, division of the ligament of Marshall and left atrial appendage excision were evaluated after 10 years for atrial fibrillation recurrence by 24 hour Holter monitoring, quality of life and symptoms by SF 36 and severity of symptom questionnaire and safety. Results: After 10.860.7 years (mean6standard deviation) follow‐up, 36 % of patients were free from atrial fibrillation and atrial tachycardia. The quality of life remained improved as compared to baseline for the mental component score, 40.44612.32 versus 48.19612.22 (p = 0.011), but not for the physical component score (39.4169.40 versus 43.44612.31, p = 0.053). The quality of life was comparable to the values of an aged matched Swedish normal population in 5 out of 8 subscales at follow‐up (figure). The symptom severity scores were also still improved as compared to baseline (12.8064.27 vs 15.1964.01, p= 0.036). Apart from 4 strokes no other events occurred. Conclusions: The clinical benefit with improvement of symptoms and quality of life remains on long‐term after minimally invasive surgical ablation and the single procedure success rate is 36 %. Larger randomized trials are warranted to confirm these results and predict which patients will benefit the most from such procedure. Left atrial appendage excision with stapler did not prevent strokes.