Frontier of Treatment of Lone Atrial Fibrillation: Can Thoracoscopic Pulmonary Vein Isolation with Ganglionated Plexus Ablation Lead?

Background: Thoracoscopic pulmonary vein isolation (PVI) with ganglionated plexus ablation is a rapidly evolving approach in the treatment of atrial fibrillation (AF). In the meanwhile, PVI with Catheter ablation (CA) strategy is increasingly performed. The data comparing these two ablative techniques are limited. Materials and Methods: An English language search of Medline for manuscripts on the treatments and outcomes of AF with theKeywords “tatrial fibrillation”, “Catheter ablation”, “thoracoscopic ablation” with cross-references was performed for articles dating from January 2006 through June 2011. Primary outcomes of interest were treatment strategies as well as the early and over-all arrhythmia related outcomes. Earlier publications studying overlapping patient groups from the same institutions were excluded. Case reports and small series of less than 30 patients were not enrolled. Results: Data regarding thoracoscopic strategy from 466 reported cases in 9 studies and data regarding CA strategy from 16660 cases in 4 studies were extracted. The gross surgical success rate was 79.4% in thoracoscopic PVI and 76.5% in CA after 1.3 procedures per patient. Conclusion: Further controlled prospective randomized studies are needed to clarify the roles of surgical and Catheter-based treatment of AF as these fields evolving rapidly. The impact of either treatment strategy on long-term sinus restoration must be evaluated in further study, as well.