Epicardial, Biatrial Ablation With Integrated Uni-bipolar Radiofrequency Technology in Stand-alone Persistent Atrial Fibrillation

Fabrizio Rosati, Claudio Muneretto, Elisa Merati, Gianluca Polvani, Massimo Moltrasio, Claudio Tondo, Antonio Curnis, Manuel Cerini, Alexandre Metras, Gianluigi Bisleri

Research output: Contribution to journalArticlepeer-review


OBJECTIVE: Although minimally invasive approaches for surgical treatment of stand-alone atrial fibrillation have gained popularity for the past decade, ablation technology and extensive lesion sets play a major role in the achievement of a successful procedure, especially in presence of persistent and long-standing persistent atrial fibrillation. We evaluated clinical outcomes after totally endoscopic biatrial epicardial ablation of persistent atrial fibrillation with a novel integrated uni-bipolar radiofrequency device.

METHODS: Forty-nine (49) consecutive patients with stand-alone atrial fibrillation underwent right-sided monolateral thoracoscopic surgical ablation with a novel integrated uni-bipolar radiofrequency energy delivery and temperature-controlled technology. Atrial fibrillation was persistent in 13 (26.5%) of 49 and long-standing persistent in 36 (73.5%) of 49 patients. Mean ± SD age was 60.6 ± 10.3 years. Median duration of atrial fibrillation was 74 months. Mean ± SD left atrial diameter was 44.7 ± 4.0 mm.

RESULTS: Epicardial en bloc isolation of all pulmonary veins (box lesion) and additional ablation of the right atrial free wall was successfully performed via minimally invasive approach without any intraoperative and postoperative major complications. Intraoperative entrance and exit block was achieved in 77.5% (38/49) and 91.8% (45/49) of patients, respectively. Mean ± SD ablation time was 16.3 ± 4.8 minutes. No intensive care unit stay was required. Postoperative sinus rhythm was achieved in 93.8% (30/32) patients, and no pacemaker implantation was required. At 13 months, 87.7% (43/49) of patients were in sinus rhythm; 71.4% (35/49) were free from antiarrhythmic drugs and 75.5% (37/49) from oral anticoagulation.

CONCLUSIONS: Integrated uni-bipolar radiofrequency ablation technology showed to be effective for the surgical treatment of atrial fibrillation with a total endoscopic approach. A versapolar suction device with extensive right-left atrial lesion set may further improve outcomes in patients with nonparoxysmal atrial fibrillation.

Original languageEnglish
Pages (from-to)114-119
Number of pages6
JournalInnovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
Issue number2
Publication statusPublished - Apr 27 2018


  • Aged
  • Atrial Appendage/anatomy & histology
  • Atrial Fibrillation/physiopathology
  • Catheter Ablation/instrumentation
  • Endoscopy/instrumentation
  • Female
  • Follow-Up Studies
  • Heart Atria/physiopathology
  • Humans
  • Intraoperative Complications/epidemiology
  • Male
  • Middle Aged
  • Minimally Invasive Surgical Procedures/statistics & numerical data
  • Pericardium/surgery
  • Postoperative Period
  • Prospective Studies
  • Pulmonary Veins/surgery
  • Thoracoscopy/methods
  • Treatment Outcome

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