Left Atrial Appendage Thrombosis and Persistent Atrial Fibrillation: combined Treatment with a Totally Thoracoscopic Approach

Abstract Minimally invasive surgical ablation is generally contraindicated in patients with atrial fibrillation and thrombosis of the left atrial appendage. We have treated three of these patients using an innovative technique based on a bilateral video-thoracoscopic approach, performing a continuous encircling lesion at the pulmonary veins outflow with radio-frequency ablation, simultaneously excluding the left atrial appendage. The postoperative course was uneventful, without neurologic events and all patients maintained a stable sinus rhythm at 1-year follow-up. This procedure represents a new mini-invasive method to treat persistent atrial fibrillation when partial thrombosis of the left atrial appendage contraindicates other ablation techniques.

摘要：微创外科消融术通常被列为合并左心耳（left atrial appendage）血栓的心房颤动（atrial fibrillation）患者的禁忌证。我们采用基于双侧电视胸腔镜入路的创新术式，对3例此类患者实施治疗：于肺静脉流出道（pulmonary veins outflow）处施行连续环形射频消融（radio-frequency ablation），同时隔离左心耳。术后病程平稳，未出现神经系统不良事件，所有患者在1年随访时均维持稳定窦性心律。该术式为合并左心耳部分血栓、其他消融技术均属禁忌的持续性心房颤动（persistent atrial fibrillation）患者提供了一种全新的微创治疗手段。