INFLUENCE OF PREVIOUS CATHETER ABLATIONS ON THE EFFICACY OF THORACOSCOPIC TREATMENT OF ATRIAL FIBRILLATION

Highlights Despite the widespread use of thoracoscopic ablations in the treatment of atrial fibrillation, accurate predictors of recurrent arrhythmia have not been established, therefore, the effectiveness of this procedure varies significantly (from 38 to 83%). According to clinical guidelines, thoracoscopic ablation should be considered in patients after primary catheter ablation. Several studies have noted that patients with a catheter ablation in history have a significantly higher risk of recurrent atrial fibrillation after thoracoscopic ablation compared with patients without catheter ablation in the 5-year follow-up period. However, our study results indicated similar prevalence of recurrent arrhythmia in patients with and without catheter ablation. Taking into account all of the above, we have evaluated the impact of previous catheter ablations on the effectiveness of thoracoscopic ablation of atrial fibrillation in the long-term follow-up period. Aim. To assess the impact of failed pulmonary vein catheter ablation (CA) on the efficacy and safety of thoracoscopic ablation (TSA) in the long-term follow-up period. Material and Methods. “Box lesion” TSA with left atrial auricle (LAA) exclusion was performed in 47 patients with CA in history and 103 patients without CA. The procedure was considered effective in the absence on 24-h HM ECG of any atrial tachyarrhythmia of more than 30 seconds duration recorded at the examination checkpoints. Results. The efficiency of TSA in the group with CA was 61,5% and 77,5% in the group without CA, with a mean follow-up period of 2,6 ± 0,83 years. Univariate and multivariate Cox proportional hazards analyses showed that prior CA statistically significantly increased the risks of atrial tachyarrhythmia recurrence by 1,936-fold (95% CI 1,931–4,026, p = 0,037) and 1,917-fold (95% CI 1,913–4,098, p = 0,042), respectively. Conclusion. The study results revealed that previous unsuccessful pulmonary vein CA may reduce the effectiveness of TSA in the long-term follow-up period. However, this topic requires further research involving multivariate analysis on a larger cohort of patients.