Off-Pump Surgical Treatment Of Lone Atrial Fibrillation For Secondary Prevention Of Ischemic Stroke

Introduction. Lone atrial fibrillation (AF) is associated with increased cardiovascular mortality and stroke, due to emboli originated in the left appendage (LAA). Despite oral anticoagulation, patients in AF remain susceptible to new thromboembolic events. Off-pump bilateral pulmonary vein isolation (OBPVI) and LAA obliteration in patients with lone AF and previous ischemic stroke is proposed.Material and methods. Six patients with a mean age of 56 years, lone AF and previous stroke underwent OBPVI (argon to -170 degrees and Cryocath Surgifrost (R) catheter, during 3 min twice in each pair of pulmonary veins) and LAA external obliteration. OBPVI was performed under transesophageal echocardiography in each application. All underwent electrophysiological study, using epicardical pacing wires placed during surgery. Isolated areas were compared to the non-isolated left atrium with respect to electrogram amplitudes and atrial capture thresholds. All patients were medicated with anti-arrhythmics and oral anticoagulation.Results. There was no hospital mortality. Inside the isolated zones the electrogram amplitude was significantly lesser than the non-isolated areas (0.3 +/- 0.1 vs. 1.4 +/- 0.8; p = 0.0075). Atrial capture thresholds were higher for the isolated areas (15.3 +/- 10.5 vs. 8.7 +/- 3.8; p = 0.14). Mean follow-up was 16.5 (12-18) months. All patients were in SR at discharge and one year after surgery, none presented new stroke events. One had self-limited paroxysmal AF during the first 3 months without clinical manifestation.Conclusions. Our initial experience in the treatment of lone AF with OBPVI with argon had good results. Long-term follow-up is needed to assess the efficacy in reducing thromboembolic events.