Minimally invasive surgical management of atrial fibrillation The role of ganglionated plexuses

This thesis focuses on minimal-invasive surgery, for atrial fibrillation (AF) and the role of ablation of the ganglionated plexuses around the heart.
A background is given and Twenty-three studies of minimal-invasive surgery for AF were reviewed. At one year, freedom from AF was 69% without AAD, and 79% with AAD.
Our initial results are reported. The complete absence of AF without AAD was 86% at one year. Our specific hybrid approach is described.
The AFACT-trial, demonstrates that GP ablation did not result in a reduction of AF recurrence and is associated with more major procedural complications, bleeding, and pacemaker implantations. It should not be performed routinely.
We followed up the first 69 of our patients to reach 5-year. In 50%, there was complete absence of AF. Irrespective of recurrences, 88% of patients were in sinus rhythm and 70% had discontinued AAD.
QoL improved in the entire cohort following thoracoscopic surgery. The most important determinant of absence of improvement was AF. One single episode appeared to decrease QoL only temporarily. Patients with complications showed no increase.
We report two patients in whom a bleeding occurred. The operations were halted and resumed later. We showed that this is a safe approach and it prevents a sternotomy.
Six patients who had undergone heart surgery up to 49 years before are described. These cases show that it is feasible to perform a safe and successful minimally-invasive thoracoscopic ablation procedure. A hybrid setup, provides the opportunity to create fewer ablation lines.