To Örebro University

OBJECTIVES: Minimally invasive surgical ablation for atrial fibrillation is an alternative to catheter ablation. Achieving lasting sinus rhythm in long-standing persistent atrial fibrillation is challenging and long-term data after surgery are limited. In 2016 we published a randomized trial comparing totally endoscopic box lesion ablation of the left atrium (case) to medical therapy (control) during one year in patients with long-standing persistent atrial fibrillation. This study presents data from a follow-up of our previous cohort to investigate the rhythm outcome long-term.

METHODS: This was an observational follow-up study. Most recent heart rhythm, time from totally endoscopic ablation to first relapse in atrial fibrillation, re-ablation, stroke, medication, left ventricular ejection fraction and mortality were gathered from medical records and analyzed with descriptive statistics and survival analysis.

RESULTS: At the end of the randomized trial, 80% of the cases had sinus rhythm without antiarrhythmic drugs. During a mean follow-up of 9 years, 43% of cases and 74% of controls had undergone additional ablation procedures (p = 0.009). At last follow-up 21% of cases and 5% of controls were in SR. After totally endoscopic ablation, mean time from surgery to first relapse in atrial fibrillation was 23 months (14-31 [95% CI] p <0.001).

CONCLUSIONS: In this population of patients with long-standing persistent atrial fibrillation, totally endoscopic box lesion ablation of the left atrium had short-term efficacy in restoring sinus rhythm. Long-term efficacy could not be demonstrated, with a high proportion of relapse in atrial fibrillation beyond one year post ablation.