Early experience of thoracoscopic vs. catheter ablation for atrial fibrillation

Background Video-assisted thoracoscopic surgical (VATS) ablation has been advocated as a treatment option for non-paroxysmal atrial fibrillation (AF) in recent guidelines. Real-life data on its safety and efficacy during a centre’s early experience are sparse. Methods 30 patients (28 persistent/longstanding persistent AF) underwent standalone VATS ablation for AF by an experienced thoracoscopic surgeon, with the first 20 cases proctored by external surgeons. Procedural and follow up outcomes were collected prospectively, and compared with 90 propensity-matched patients undergoing contemporaneous catheter ablation (CA). Results 6 (20.0%) patients undergoing VATS ablation experienced ≥1 major complication (death n=1, stroke n=2, conversion to sternotomy n=3, phrenic nerve injury n=2). This was significantly higher than the 1.1% major complication rate (tamponade requiring drainage n=1) seen with CA (p<0.001). 12-month single procedure arrhythmia-free survival rates without antiarrhythmic drugs were 56% in the VATS and 57% in the CA cohorts (p=0.22), and 78% and 80% respectively given an additional CA and antiarrhythmic drugs (p=0.32). Conclusions During a centre’s early experience, VATS ablation may have similar success rates to those from an established CA service, but carry a greater risk of major complications. Those embarking on a programme of VATS AF ablation should be aware that complication and success rates may differ from those reported by selected high volume centres.