{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T22:36:22Z","timestamp":1757543782917,"version":"3.37.3"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2021,3,29]],"date-time":"2021-03-29T00:00:00Z","timestamp":1616976000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,10,22]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>\u2002<\/jats:title>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>Previous series showed the outcomes of thoracoscopic ablation of stand-alone symptomatic paroxysmal atrial fibrillation (AF) for up to 7\u2009years of follow-up. The goal of this study was to assess the long-term durability of surgical pulmonary vein isolation (PVI) beyond 7\u2009years.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>Fifty consecutive patients {mean age 55 [standard deviation (SD): 11.2] years, previous catheter ablation in 56%, left ventricular ejection fraction 60% (SD: 4.6), left atrium volume 65\u2009ml (SD: 17)} with stand-alone symptomatic paroxysmal AF underwent PVI through bilateral thoracoscopy ablation between 2005 and 2014. The CHA2DS2-VASc score was \u22652 in 12 patients (24%).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>No hospital deaths occurred. At hospital discharge all patients but 1 (2%) were in sinus rhythm (SR). Follow-up was 100% complete [mean 8.4\u2009years (SD: 2.3), max 15]. The 8-year cumulative incidence function of AF recurrence, with death as a competing risk, on or off class I\/III antiarrhythmic drugs (AADs)\/electrocardioversion\/re-transcatheter ablation (TCA) was 20% (SD: 5; 95% confidence interval: 10, 32); and off class I\/III AADs\/electrocardioversion\/re-TCA was 52% (SD: 7; 95% confidence interval: 0.83, 8.02). At 8\u2009years, the predicted prevalence of patients in SR was 87% and 53% were off class I\/III AADs\/electrocardioversion\/re-TCA. The recurrent arrhythmia was AF in all patients except 2, who had atypical atrial flutter (4%). No predictors of AF recurrence were identified. At the last follow-up, 76% of the patients showed European Heart Rhythm Association class I. No strokes or thromboembolic events were documented and 76% of the subjects were off anticoagulation therapy.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Despite a considerable AF recurrence rate, our single-centre, long-term outcome of surgical PVI showed encouraging data, with the majority of patients remaining in SR, although many of them were on antiarrhythmic therapy.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejcts\/ezab138","type":"journal-article","created":{"date-parts":[[2021,2,21]],"date-time":"2021-02-21T07:08:55Z","timestamp":1613891335000},"page":"850-856","source":"Crossref","is-referenced-by-count":2,"title":["Long-term results of thoracoscopic ablation of paroxysmal atrial fibrillation: is the glass half full or half empty?"],"prefix":"10.1093","volume":"60","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4618-7520","authenticated-orcid":false,"given":"Igor","family":"Belluschi","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisabetta","family":"Lapenna","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8775-3464","authenticated-orcid":false,"given":"Davide","family":"Carino","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2410-3218","authenticated-orcid":false,"given":"Cinzia","family":"Trumello","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Manuela","family":"Cireddu","sequence":"additional","affiliation":[{"name":"Department of Cardiac Electrophysiology and Arrhythmia, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefania","family":"Ruggeri","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3081-1678","authenticated-orcid":false,"given":"Davide","family":"Schiavi","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5186-1976","authenticated-orcid":false,"given":"Fabrizio","family":"Monaco","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Anesthesia and Intensive Care, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alberto","family":"Pozzoli","sequence":"additional","affiliation":[{"name":"Heart Surgery Unit, Zurich University Hospital, Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eustachio","family":"Agricola","sequence":"additional","affiliation":[{"name":"Cardiovascular Imaging Unit, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1065-8052","authenticated-orcid":false,"given":"Ottavio","family":"Alfieri","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9329-7437","authenticated-orcid":false,"given":"Michele","family":"De Bonis","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, IRCCS San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6511-8681","authenticated-orcid":false,"given":"Stefano","family":"Benussi","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Spedali Civili di Brescia, University Hospital, Brescia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,3,29]]},"reference":[{"key":"2021102217440930800_ezab138-B1","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1161\/CIRCULATIONAHA.105.595140","article-title":"Secular trends in incidence of atrial fibrillation in Olmsted County, Minnesota, 1980 to 2000 and implications on the projections for future prevalence","volume":"114","author":"Miyasaka","year":"2006","journal-title":"Circulation"},{"key":"2021102217440930800_ezab138-B2","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1093\/europace\/eux274","article-title":"HRS\/EHRA\/ECAS\/APHRS\/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation","volume":"20","author":"Calkins","year":"2018","journal-title":"Europace"},{"key":"2021102217440930800_ezab138-B3","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1093\/eurheartj\/ehaa612","article-title":"2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-thoracic Surgery (EACTS). The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC). Developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC","volume":"42","author":"Hindricks","year":"2021","journal-title":"Eur Heart J"},{"key":"2021102217440930800_ezab138-B4","doi-asserted-by":"crossref","first-page":"797","DOI":"10.1016\/j.jtcvs.2005.03.041","article-title":"Video-assisted bilateral pulmonary vein isolation and left atrial appendage exclusion for atrial fibrillation","volume":"130","author":"Wolf","year":"2005","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2021102217440930800_ezab138-B5","doi-asserted-by":"crossref","first-page":"823","DOI":"10.1016\/j.jtcvs.2009.11.065","article-title":"Pulmonary vein isolation and autonomic denervation for the management of paroxysmal atrial fibrillation by a minimally invasive surgical approach","volume":"140","author":"Edgerton","year":"2010","journal-title":"J Thorac Cardiovasc Surg"},{"key":"2021102217440930800_ezab138-B6","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1161\/CIRCEP.109.854828","article-title":"Results of a minimally invasive surgical pulmonary vein isolation and ganglionic plexi ablation for atrial fibrillation: single-center experience with 12-month follow-up","volume":"2","author":"Han","year":"2009","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"2021102217440930800_ezab138-B7","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1007\/s10840-011-9650-5","article-title":"Feasibility and efficacy of minimally invasive stand-alone surgical ablation of atrial fibrillation. A single-center experience","volume":"34","author":"Santini","year":"2012","journal-title":"J Interv Card Electrophysiol"},{"key":"2021102217440930800_ezab138-B8","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1097\/imi.0000000000000029","article-title":"Surgical minimally invasive pulmonary vein isolation for lone atrial fibrillation","volume":"8","author":"De Maat","year":"2013","journal-title":"Innovations (Phila)"},{"key":"2021102217440930800_ezab138-B9","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1093\/europace\/eut208","article-title":"Surgical vs. transcatheter pulmonary vein isolation as first invasive treatment in patients with atrial fibrillation: a matched group comparison","volume":"16","author":"De Maat","year":"2014","journal-title":"Europace"},{"key":"2021102217440930800_ezab138-B10","doi-asserted-by":"crossref","first-page":"e79755","DOI":"10.1371\/journal.pone.0079755","article-title":"Long-term results of a minimally invasive surgical pulmonary vein isolation and ganglionic plexi ablation for atrial fibrillation","volume":"8","author":"Zheng","year":"2013","journal-title":"PLoS One"},{"key":"2021102217440930800_ezab138-B11","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1093\/europace\/euu287","article-title":"Long-term results of surgical minimally invasive pulmonary vein isolation for paroxysmal lone atrial fibrillation","volume":"17","author":"De Maat","year":"2015","journal-title":"Europace"},{"key":"2021102217440930800_ezab138-B12","doi-asserted-by":"crossref","first-page":"1049","DOI":"10.2307\/2531734","article-title":"Models for longitudinal data: a generalized estimating equation approach","volume":"44","author":"Zeger","year":"1988","journal-title":"Biometrics"},{"key":"2021102217440930800_ezab138-B13","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.1161\/01.CIR.0000157153.30978.67","article-title":"Worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation","volume":"111","author":"Cappato","year":"2005","journal-title":"Circulation"},{"key":"2021102217440930800_ezab138-B14","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1016\/j.jacc.2014.04.072","article-title":"Paroxysmal AF catheter ablation with a contact force sensing catheter. Results of the prospective, multicenter SMART-AF trial","volume":"64","author":"Natale","year":"2014","journal-title":"JACC"},{"key":"2021102217440930800_ezab138-B15","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1093\/europace\/euv060","article-title":"Comparison between radiofrequency with contact force-sensing and second-generation cryoballoon for paroxysmal atrial fibrillation catheter ablation: a multicenter European evaluation","volume":"17","author":"Squara","year":"2015","journal-title":"Europace"},{"key":"2021102217440930800_ezab138-B16","article-title":"Temperature-guided ablation with the second-generation cryoballoon for paroxysmal atrial fibrillation: 3-year follow-up in a multicenter experience","author":"Papparella","year":"2020","journal-title":"J Interv Card Electrophysiol"},{"key":"2021102217440930800_ezab138-B17","doi-asserted-by":"crossref","first-page":"2368","DOI":"10.1161\/CIRCULATIONAHA.110.946806","article-title":"Long-term results of catheter ablation in paroxysmal atrial fibrillation. Lessons from a 5-year follow-up","volume":"122","author":"Ouyang","year":"2010","journal-title":"Circulation"},{"key":"2021102217440930800_ezab138-B18","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/j.jacc.2010.05.061","article-title":"Catheter ablation for atrial fibrillation. Are results maintained at 5 years of follow-up?","volume":"57","author":"Weerasooriya","year":"2011","journal-title":"JACC"},{"key":"2021102217440930800_ezab138-B19","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1093\/europace\/eux008","article-title":"Very long-term outcome following transcatheter ablation of atrial fibrillation. Are results maintained after 10 years of follow-up?","volume":"20","author":"Gaita","year":"2018","journal-title":"Europace"},{"key":"2021102217440930800_ezab138-B20","doi-asserted-by":"crossref","first-page":"102","DOI":"10.1093\/icvts\/ivw311","article-title":"The totally thoracoscopic maze procedure for the treatment of atrial fibrillation","volume":"24","author":"van Laar","year":"2017","journal-title":"Interact CardioVasc Thorac Surg"},{"key":"2021102217440930800_ezab138-B21","doi-asserted-by":"crossref","first-page":"1044","DOI":"10.1093\/ejcts\/ezv180","article-title":"Thoracoscopic surgical ablation versus catheter ablation for atrial fibrillation","volume":"49","author":"Phan","year":"2016","journal-title":"Eur J Cardiothorac Surg"},{"key":"2021102217440930800_ezab138-B22","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13019-019-1018-4","article-title":"Safety and long-term efficacy of thoracoscopic epicardial ablation in patients with paroxysmal atrial fibrillation: a retrospective study","volume":"14","author":"Johnkoski","year":"2019","journal-title":"J Cardiothorac Surg"},{"key":"2021102217440930800_ezab138-B23","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1093\/europace\/euy325","article-title":"Thoracoscopic vs. catheter ablation for atrial fibrillation: long-term follow-up of the FAST randomized trial","volume":"21","author":"Castella","year":"2019","journal-title":"Europace"},{"key":"2021102217440930800_ezab138-B24","first-page":"2567","article-title":"Comparative study of video-assisted thoracoscopic surgery ablation and radiofrequency catheter ablation on treating paroxysmal atrial fibrillation: a randomized, controlled short-term trial","volume":"127","author":"Wang","year":"2014","journal-title":"Chin Med J (Engl)"},{"key":"2021102217440930800_ezab138-B25","doi-asserted-by":"crossref","first-page":"1338","DOI":"10.1111\/jce.12245","article-title":"Catheter versus surgical ablation of atrial fibrillation after a failed initial pulmonary vein isolation procedure: a randomized controlled trial","volume":"24","author":"Pokushalov","year":"2013","journal-title":"J Cardiovasc Electrophysiol"},{"key":"2021102217440930800_ezab138-B26","doi-asserted-by":"crossref","first-page":"1790","DOI":"10.1093\/europace\/eux385","article-title":"Totally thoracoscopic ablation for atrial fibrillation: a systematic safety analysis","volume":"20","author":"Vos","year":"2018","journal-title":"Europace"}],"container-title":["European Journal of Cardio-Thoracic Surgery"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/ejcts\/article-pdf\/60\/4\/850\/40824110\/ezab138.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/ejcts\/article-pdf\/60\/4\/850\/40824110\/ezab138.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,10,22]],"date-time":"2021-10-22T17:31:18Z","timestamp":1634923878000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ejcts\/article\/60\/4\/850\/6199216"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,29]]},"references-count":26,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,3,29]]},"published-print":{"date-parts":[[2021,10,22]]}},"URL":"https:\/\/doi.org\/10.1093\/ejcts\/ezab138","relation":{},"ISSN":["1010-7940","1873-734X"],"issn-type":[{"type":"print","value":"1010-7940"},{"type":"electronic","value":"1873-734X"}],"subject":[],"published-other":{"date-parts":[[2021,10,1]]},"published":{"date-parts":[[2021,3,29]]}}}