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However, surgical AF ablation with unknown efficacy is being performed in patients with a giant LA (GLA). We determined efficacy of thoracoscopic AF ablation in patients with compared to without a GLA.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>Patients underwent thoracoscopic PVI with additional left atrial ablations lines (in persistent AF) and were prospectively followed up. GLA was defined as LA volume index (LAVI)\u2009\u2265\u200950\u00a0ml\/m<jats:sup>2<\/jats:sup>. Follow-up was performed with ECGs and 24-h Holters every 3\u00a0months. After a 3-month blanking period, all antiarrhythmic drugs were discontinued. The primary outcome was freedom of any atrial tachyarrhythmia\u2009\u2265\u200930\u00a0s during 2\u00a0years of follow-up.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>At baseline, 68 (15.4%) patients had a GLA (LAVI: 56.7 [52.4\u201362.8] ml\/m<jats:sup>2<\/jats:sup>), while 374 (84.6%) had a smaller LA (LAVI: 34.8 [29.2\u201341.3] ml\/m<jats:sup>2<\/jats:sup>). GLA patients were older (61.9\u2009\u00b1\u20096.9 vs 59.4\u2009\u00b1\u20098.8\u00a0years, <jats:italic>p<\/jats:italic>\u2009=\u20090.02), more often diagnosed with persistent AF (76.5% vs 58.6%, <jats:italic>p<\/jats:italic>\u2009=\u20090.008). Sex was equally distributed (with approximately 25% females). GLA patients had more recurrences compared to non-GLA patients at 2-year follow-up (42.6% vs 57.2%, log rank <jats:italic>p<\/jats:italic>\u2009=\u20090.02). Freedom of AF was 69.0% in non-GLA paroxysmal AF patients compared to 43.8\u201349.3% in a combined group of GLA and\/or persistent AF patients(log rank <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). Furthermore, freedom was 62.4% in non-GLA male patients, compared to 43.8\u201347.4 in a combined group of GLA and\/or female sex(log rank <jats:italic>p<\/jats:italic>\u2009=\u20090.02).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Thoracoscopic AF ablation is an effective therapy in a substantial part of GLA patients. Thoracoscopic AF ablation may serve as a last resort treatment option in these patients.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1007\/s10840-021-01056-1","type":"journal-article","created":{"date-parts":[[2021,9,16]],"date-time":"2021-09-16T09:02:42Z","timestamp":1631782962000},"page":"469-478","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Thoracoscopic surgical atrial fibrillation ablation in patients with an extremely enlarged left atrium"],"prefix":"10.1007","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8733-0867","authenticated-orcid":false,"given":"Jolien","family":"Neefs","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin","family":"Wesselink","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicoline W. 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The study complies with the Declaration of Helsinki.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval"}},{"value":"All patients provided written informed consent.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed consent"}},{"value":"Joris R. de Groot is supported by a personal grant from The Netherlands Organisation for Health Research and Development (ZonMW\/NOW), 106.146.310, received research grants from Medtronic, Abbott and AtriCure and is consultant for Atricure, Daiichi Sankyo and Bayer outside the submitted work. Antoine H.G. Driessen is a consultants for Atricure. The other authors report no disclosures.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}