{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T19:33:56Z","timestamp":1782934436926,"version":"3.54.5"},"reference-count":24,"publisher":"Springer Science and Business Media LLC","issue":"2","license":[{"start":{"date-parts":[[2015,12,21]],"date-time":"2015-12-21T00:00:00Z","timestamp":1450656000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Neth Heart J"],"published-print":{"date-parts":[[2016,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Introduction<\/jats:title>\n            <jats:p>Catheter ablation of longstanding (&gt;\u20091 year) persistent atrial fibrillation (AF) is associated with poor outcome. This might be due to remodelling and fibrosis formation, mainly located in the posterior left atrial (LA) wall. Therefore, we adopted a thoracoscopic epicardial box isolation of the posterior left atrium using bipolar RF energy with intraoperative testing of conduction block.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods and results<\/jats:title>\n            <jats:p>Bilateral thoracoscopic box isolation was performed with a bipolar RF clamp. Entrance block was defined as absence of a conducted electrogram within the box, while exit block was confirmed by pacing at 10.0\u00a0V\/2\u00a0ms. Ablation outcome was evaluated after 3, 6, 12 and 24 months with 12-lead ECGs and 24-hour Holter recordings.<\/jats:p>\n            <jats:p>Twenty-five consecutive patients were included (58\u2009\u00b1\u20097 years, persistent AF duration 1.8\u2009\u00b1\u20090.9 years). Entrance block was achieved in all patients and exit block confirmed if sinus rhythm was achieved. After 17\u2009\u00b1\u20097 months, 76\u2009% of the patients (<jats:italic>n<\/jats:italic>\u2009=\u200919) were free of AF recurrence. One patient died within 1 month and was considered an ablation failure. Four patients with AF recurrences regained sinus rhythm with additional catheter ablation or antiarrhythmic drugs.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Treatment of longstanding persistent AF with thoracoscopic epicardial LA posterior box isolation using bipolar RF energy with intraoperative testing of conduction block is feasible and highly effective.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s12471-015-0785-3","type":"journal-article","created":{"date-parts":[[2015,12,21]],"date-time":"2015-12-21T14:15:00Z","timestamp":1450707300000},"page":"143-151","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Outcome of stand-alone thoracoscopic epicardial left atrial posterior box isolation with bipolar radiofrequency energy for longstanding persistent atrial fibrillation"],"prefix":"10.1007","volume":"24","author":[{"given":"M. G.","family":"Compier","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Braun","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Tjon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K.","family":"Zeppenfeld","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. J. M.","family":"Klautz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. J.","family":"Schalij","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. A.","family":"Trines","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2015,12,21]]},"reference":[{"key":"785_CR1","doi-asserted-by":"publisher","first-page":"659","DOI":"10.1056\/NEJM199809033391003","volume":"339","author":"M Haissaguerre","year":"1998","unstructured":"Haissaguerre M, Jais P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med. 1998;339:659\u201366.","journal-title":"N Engl J Med"},{"key":"785_CR2","doi-asserted-by":"publisher","first-page":"1077","DOI":"10.1161\/hc0902.104712","volume":"105","author":"H Oral","year":"2002","unstructured":"Oral H, Knight BP, Tada H, et al. Pulmonary vein isolation for paroxysmal and persistent atrial fibrillation. Circulation. 2002;105:1077\u201381.","journal-title":"Circulation"},{"key":"785_CR3","doi-asserted-by":"publisher","first-page":"1686","DOI":"10.1016\/j.jtcvs.2003.06.002","volume":"126","author":"JL Cox","year":"2003","unstructured":"Cox JL. Atrial fibrillation I: a new classification system. J Thorac Cardiovasc Surg. 2003;126:1686\u201392.","journal-title":"J Thorac Cardiovasc Surg"},{"key":"785_CR4","doi-asserted-by":"publisher","first-page":"1976","DOI":"10.1001\/jama.1991.03470140088029","volume":"266","author":"JL Cox","year":"1991","unstructured":"Cox JL, Boineau JP, Schuessler RB, et al. Successful surgical treatment of atrial fibrillation. Review and clinical update. JAMA. 1991;266:1976\u201380.","journal-title":"JAMA"},{"key":"785_CR5","doi-asserted-by":"publisher","first-page":"1758","DOI":"10.1161\/CIRCULATIONAHA.108.811877","volume":"119","author":"RS Oakes","year":"2009","unstructured":"Oakes RS, Badger TJ, Kholmovski EG, et al. Detection and quantification of left atrial structural remodelling with delayed-enhancement magnetic resonance imaging in patients with atrial fibrillation. Circulation. 2009;119:1758\u201367.","journal-title":"Circulation"},{"key":"785_CR6","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1111\/j.1540-8167.2011.02178.x","volume":"23","author":"AW Teh","year":"2012","unstructured":"Teh AW, Kistler PM, Lee G, et al. Electroanatomic remodelling of the left atrium in paroxysmal and persistent atrial fibrillation patients without structural heart disease. J Cardiovasc Electrophysiol. 2012;23:232\u20138.","journal-title":"J Cardiovasc Electrophysiol"},{"key":"785_CR7","doi-asserted-by":"publisher","first-page":"968","DOI":"10.1161\/CIRCEP.111.970293","volume":"5","author":"TW Lim","year":"2012","unstructured":"Lim TW, Koay CH, See VA, et al. Single-ring posterior left atrial (box) isolation results in a different mode of recurrence compared with wide antral pulmonary vein isolation on long-term follow-up: longer atrial fibrillation-free survival time but similar survival time free of any atrial arrhythmia. Circ Arrhythm Electrophysiol. 2012;5:968\u201377.","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"785_CR8","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1007\/s10840-007-9172-3","volume":"20","author":"JC Pruitt","year":"2007","unstructured":"Pruitt JC, Lazzara RR, Ebra G. Minimally invasive surgical ablation of atrial fibrillation: the thoracoscopic box lesion approach. J Interv Card Electrophysiol. 2007;20:83\u20137.","journal-title":"J Interv Card Electrophysiol"},{"key":"785_CR9","doi-asserted-by":"publisher","first-page":"101","DOI":"10.5761\/atcs.oa.11.01733","volume":"18","author":"T Sueda","year":"2012","unstructured":"Sueda T, Uchida N, Takasaki T, et al. Long-term results after the box pulmonary vein isolation procedure for chronic atrial fibrillation in mitral valve surgery. Ann Thorac Cardiovasc Surg. 2012;18:101\u20138.","journal-title":"Ann Thorac Cardiovasc Surg"},{"key":"785_CR10","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1007\/s12471-013-0513-9","volume":"22","author":"A Yaksh","year":"2014","unstructured":"Yaksh A, Kik C, Knops P, et al. Atrial fibrillation: to map or not to map? Neth Heart J. 2014;22:259\u201366.","journal-title":"Neth Heart J"},{"key":"785_CR11","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1007\/s12471-014-0624-y","volume":"23","author":"P Gal","year":"2015","unstructured":"Gal P, Smit JJ, Adiyaman A, Ramdat Misier AR, Delnoy PP, Elvan A. First Dutch experience with the endoscopic laser balloon ablation system for the treatment of atrial fibrillation. Neth Heart J. 2015;23:96\u20139.","journal-title":"Neth Heart J"},{"key":"785_CR12","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1007\/s12471-013-0483-y","volume":"22","author":"LJ de Vries","year":"2014","unstructured":"Vries LJ de, Akca F, Khan M, et al. Clinical outcome of ablation for long-standing persistent atrial fibrillation with or without defragmentation. Neth Heart J. 2014;22:30\u20136.","journal-title":"Neth Heart J"},{"key":"785_CR13","doi-asserted-by":"publisher","first-page":"1047","DOI":"10.1111\/j.1540-8167.2007.00911.x","volume":"18","author":"K Kumagai","year":"2007","unstructured":"Kumagai K, Muraoka S, Mitsutake C, Takashima H, Nakashima H. A new approach for complete isolation of the posterior left atrium including pulmonary veins for atrial fibrillation. J Cardiovasc Electrophysiol. 2007;18:1047\u201352.","journal-title":"J Cardiovasc Electrophysiol"},{"key":"785_CR14","doi-asserted-by":"publisher","first-page":"722","DOI":"10.1016\/j.hrthm.2007.01.034","volume":"4","author":"SP Thomas","year":"2007","unstructured":"Thomas SP, Lim TW, McCall R, Seow SC, Ross DL. Electrical isolation of the posterior left atrial wall and pulmonary veins for atrial fibrillation: feasibility of and rationale for a single-ring approach. Heart Rhythm. 2007;4:722\u201330.","journal-title":"Heart Rhythm"},{"key":"785_CR15","doi-asserted-by":"publisher","first-page":"1862","DOI":"10.1093\/eurheartj\/ehl548","volume":"28","author":"P Sanders","year":"2007","unstructured":"Sanders P, Hocini M, Jais P, et al. Complete isolation of the pulmonary veins and posterior left atrium in chronic atrial fibrillation. Long-term clinical outcome. Eur Heart J. 2007;28:1862\u201371.","journal-title":"Eur Heart J"},{"key":"785_CR16","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1093\/europace\/eun029","volume":"10","author":"J Chen","year":"2008","unstructured":"Chen J, Off MK, Solheim E, Schuster P, Hoff PI, Ohm OJ. Treatment of atrial fibrillation by silencing electrical activity in the posterior inter-pulmonary-vein atrium. Europace. 2008;10:265\u201372.","journal-title":"Europace"},{"key":"785_CR17","doi-asserted-by":"publisher","first-page":"233","DOI":"10.1253\/circj.CJ-08-0700","volume":"73","author":"K Kumagai","year":"2009","unstructured":"Kumagai K, Nakashima H. Noncontact mapping-guided catheter ablation of atrial fibrillation. Circ J. 2009;73:233\u201341.","journal-title":"Circ J"},{"key":"785_CR18","doi-asserted-by":"publisher","first-page":"797","DOI":"10.1016\/j.jtcvs.2005.03.041","volume":"130","author":"RK Wolf","year":"2005","unstructured":"Wolf RK, Schneeberger EW, Osterday R, et al. Video-assisted bilateral pulmonary vein isolation and left atrial appendage exclusion for atrial fibrillation. J Thorac Cardiovasc Surg. 2005;130:797\u2013802.","journal-title":"J Thorac Cardiovasc Surg"},{"key":"785_CR19","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1111\/j.1540-8191.2008.00747.x","volume":"24","author":"Y Miyagi","year":"2009","unstructured":"Miyagi Y, Ishii Y, Nitta T, Ochi M, Shimizu K. Electrophysiological and histological assessment of transmurality after epicardial ablation using unipolar radiofrequency energy. J Card Surg. 2009;24:34\u201340.","journal-title":"J Card Surg"},{"key":"785_CR20","doi-asserted-by":"publisher","first-page":"293","DOI":"10.3109\/13645706.2011.615329","volume":"21","author":"JR de Groot","year":"2012","unstructured":"Groot JR de, Driessen AH, Van Boven WJ, et al. Epicardial confirmation of conduction block during thoracoscopic surgery for atrial fibrillation\u2013a hybrid surgical-electrophysiological approach. Minim Invasive Ther Allied Technol. 2012;21:293\u2013301.","journal-title":"Minim Invasive Ther Allied Technol"},{"key":"785_CR21","doi-asserted-by":"publisher","first-page":"229","DOI":"10.1016\/j.ijcard.2014.02.043","volume":"173","author":"SP Krul","year":"2014","unstructured":"Krul SP, Pison L, La Meir M, et al. Epicardial and endocardial electrophysiological guided thoracoscopic surgery for atrial fibrillation: a multidisciplinary approach of atrial fibrillation ablation in challenging patients. Int J Cardiol. 2014;173:229\u201335.","journal-title":"Int J Cardiol"},{"key":"785_CR22","doi-asserted-by":"publisher","first-page":"1622","DOI":"10.1016\/S0735-1097(01)01193-7","volume":"37","author":"S Yuda","year":"2001","unstructured":"Yuda S, Nakatani S, Kosakai Y, Yamagishi M, Miyatake K. Long-term follow-up of atrial contraction after the maze procedure in patients with mitral valve disease. J Am Coll Cardiol. 2001;37:1622\u201327.","journal-title":"J Am Coll Cardiol"},{"key":"785_CR23","doi-asserted-by":"publisher","first-page":"1614","DOI":"10.1016\/j.jacc.2011.05.051","volume":"58","author":"J Buber","year":"2011","unstructured":"Buber J, Luria D, Sternik L, et al. Left atrial contractile function following a successful modified Maze procedure at surgery and the risk for subsequent thromboembolic stroke. J Am Coll Cardiol. 2011;58:1614\u201321.","journal-title":"J Am Coll Cardiol"},{"key":"785_CR24","doi-asserted-by":"publisher","first-page":"823","DOI":"10.1016\/j.jtcvs.2009.11.065","volume":"140","author":"JR Edgerton","year":"2010","unstructured":"Edgerton JR, Brinkman WT, Weaver T, et al. Pulmonary vein isolation and autonomic denervation for the management of paroxysmal atrial fibrillation by a minimally invasive surgical approach. J Thorac Cardiovasc Surg. 2010;140:823\u20138.","journal-title":"J Thorac Cardiovasc Surg"}],"container-title":["Netherlands Heart Journal"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s12471-015-0785-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1007\/s12471-015-0785-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1007\/s12471-015-0785-3","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s12471-015-0785-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,2]],"date-time":"2021-09-02T20:02:14Z","timestamp":1630612934000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s12471-015-0785-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,12,21]]},"references-count":24,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2016,2]]}},"alternative-id":["785"],"URL":"https:\/\/doi.org\/10.1007\/s12471-015-0785-3","relation":{},"ISSN":["1568-5888","1876-6250"],"issn-type":[{"value":"1568-5888","type":"print"},{"value":"1876-6250","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,12,21]]},"assertion":[{"value":"21 December 2015","order":1,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The Department of Cardiology receives unrestricted research and fellowship grants from Boston Scientific, Medtronic and Biotronik. K. Zeppenfeld receives consulting fees from St. Jude Medical.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}