# A Retrospective Long-Term Follow-Up of the Randomized Study: Total Endoscopic Ablation of Patients With Long-Standing Persistent Atrial Fibrillation

## TL;DR

This study followed patients with long-standing atrial fibrillation for 9 years after a minimally invasive ablation procedure, finding that while it helped restore normal heart rhythm in the short term, long-term results were less effective.

## Contribution

The study provides long-term follow-up data (mean 9 years) on the efficacy of totally endoscopic ablation for long-standing persistent atrial fibrillation.

## Key findings

- 80% of ablated patients had sinus rhythm without drugs after the initial trial.
- 43% of ablated patients and 74% of controls underwent additional ablation procedures (P = .009).
- 21% of ablated patients and 5% of controls were in sinus rhythm at last follow-up.

## Abstract

Minimally invasive surgical ablation for atrial fibrillation is an alternative to catheter ablation. Achieving a lasting sinus rhythm in long-standing persistent atrial fibrillation is challenging, and long-term data after surgery are limited. In 2016, we published a randomized trial comparing totally endoscopic box lesion ablation of the left atrium (case) to medical therapy (control) during 1 year in patients with long-standing persistent atrial fibrillation. This study presents data from a follow-up of our previous cohort to investigate the rhythm outcome long-term.

This was an observational follow-up study. Most recent heart rhythm, time from totally endoscopic ablation to first relapse in atrial fibrillation, re-ablation, stroke, medication, left ventricular ejection fraction, and mortality were gathered from medical records and analysed with descriptive statistics and survival analysis.

At the end of the randomized trial, 80% of the cases had sinus rhythm without antiarrhythmic drugs. During a mean follow-up of 9 years, 43% of cases and 74% of controls had undergone additional ablation procedures (P = .009). At the last follow-up, 21% of cases and 5% of controls were in SR. After totally endoscopic ablation, the mean time from surgery to first relapse in atrial fibrillation was 23 months (14-31 [95% CI] P < .001).

In this population of patients with long-standing persistent atrial fibrillation, totally endoscopic box lesion ablation of the left atrium had short-term efficacy in restoring sinus rhythm. Long-term efficacy could not be demonstrated, with a high proportion of relapse in atrial fibrillation beyond 1 year post ablation.

Atrial fibrillation (AF) is the most common cardiac arrhythmia worldwide and is associated with an increased risk of cardiac and cerebrovascular morbidity and mortality.