Purpose

Thoracoscopic surgical ablation is a minimally invasive ablation procedure used to treat atrial fibrillation (AFib), a common type of arrhythmia, when the condition does not respond to drug therapy. Some types of arrhythmias arise when the electrical signaling pathway through the heart becomes disrupted and alternate abnormal signaling pathways arise.

Thoracoscopic surgical ablation consists of three steps. First, radio-frequency (energy) waves destroy the extra heart cells disrupting the electrical pathway. This helps in restoring the heart’s normal signaling abilities. Second, some nerves around the heart are also destroyed. Finally, a piece of muscle called the left atrial appendage is removed. Together, these steps help to stop the abnormal signaling and reduce the risk for blood clot formation.

Description

  • The patient has blood tests, an electrocardiogram, an angiogram, an echocardiogram, and in some cases a CT scan, performed in the hospital before the procedure.
  • A nurse or doctor asks the patient to provide informed consent. This is required before the procedure can be performed.
  • The patient is taken to the Cardiac Operating Room.
  • The patient is placed under general anesthesia and remains unconscious throughout the operation.
  • Small cuts (4-5 cm) are made on each side of the patient’s chest. The breastbone is not cut. A thoracoscope (a thin tube with a tiny fiber optic camera on the end) is then inserted into the chest. The camera transmits real-time photos of the heart onto a video monitor.
  • Specialized wires and a radio-frequency clamp are then guided through onto the pulmonary veins, to the point where the veins meet the atria (the upper chambers of the heart).
  • Radio-frequency waves are sent through the clamp to create scar tissue where the veins meet the atria, to block abnormal signaling.
  • A small radio-frequency energy pen is also inserted and used to destroy several nerve clusters on the outside of the heart.
  • A special miniature stapler is inserted and used to remove the left atrial appendage to reduce the risk of future blood clots and stroke.
  • The wires and endoscopes are removed from the body, and all incisions are closed.
  • The patient stays in the Cardiac Intensive Care Unit (ICU) for about a day.
  • The patient is moved to a regular hospital room. The average hospital stay after thoracoscopic surgical ablation is four to seven days.