Thoracoscopic ablation for the treatment of atrial fibrillation and concomitant left atrial appendage closure

Atrial fibrillation (AF) is a common health problem with rising incidence and prevalence, and high rates of stroke and mortality. The 2016 guidelines from the European Society of Cardiology indicate a Class 2a level of evidence for totally thoracoscopic maze in patients with symptomatic AF refractory to anti-arrhythmic drug therapy to improve symptoms. In the first part of this thesis we assess the clinical success and safety of this thoracoscopic ablation technique for the treatment of AF. These results should provide cardiologists, cardiac surgeons, the AF Heart Team and general practitioners with more adequate information to guide their decision making regarding rhythm control therapy for stand-alone AF patients. Based on the data from this thesis and the current literature, we conclude that thoracoscopic ablation has become an effective and safe rhythm control therapy resulting in reasonable and reproducible reduction of short- and long-term incidence of AF with acceptable complication rates and a clear indication to reduced stroke rates during follow-up. In the second part of this thesis we focused on the effectiveness of concomitant left atrial appendage (LAA) closure. We have shown that thoracoscopic clipping of the LAA is a feasible and safe LAA closure approach with lower than expected rates of stroke after deployment. The low stroke risk was the results of the combined effect of rhythm control therapy, LAA closure and oral anticoagulation therapy during follow-up.