Totally Thoracoscopic Ablation for Atrial Fibrillation: All-Box Clamping

Epicardial surgical ablation is an effective strategy to treat non-paroxysmal forms of atrial fibrillation. Current thoracoscopic epicardial surgical strategies are complex, and are therefore often avoided. With slight modifications to the thoracoscopic maze procedure, totally thoracoscopic all-box clamping may facilitate the performance of epicardial thoracoscopic ablation, while maintaining good results.Between December 2023 and December 2024, 42 patients underwent thoracoscopic all-box clamping at a single center. All-box clamping uses commercially available bipolar radiofrequency clamps for isolation of the ipsilateral pulmonary veins and posterior left atrial wall through right and then left-sided thoracoscopic access. The left atrial appendage is occluded using a clip device, and the ligament of Marshall is transected. Assessment of a bidirectional block confirmed electrical isolation. Data from the CASE-AF registry were analyzed retrospectively. Short-term results pertaining to efficacy and safety are provided.All-box clamping was successfully offered to all patients by three surgeons. There were no reported major or minor complications. The median hospital stay was 6 days (interquartile range 5-6). At discharge, a sinus rhythm was observed in 92.9%, and in 76.1% of patients off any class I/III antiarrhythmic drugs.Surgical ablation with a modified thoracoscopic technique is safe and feasible for the treatment of atrial fibrillation.