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.