Modified mini-maze via left thoracic cavity under VATS for paroxysmal
atrial fibrillation in a patient with complete interruption of the
inferior vena cava
Abstract
Objectives: We sought to determine the technical feasibility of surgical
bipolar radiofrequency ablation (endoscopic maze procedure) through the
left chest cavity in patients with an interrupted inferior vena cava
(IVC). Methods and Results: A 57-year-old female with paroxysmal atrial
fibrillation (AF) and an interrupted IVC was referred to our hospital
for radiofrequency ablation. Transseptal puncture and left atrium (LA)
ablation failed through a standard IVC approach via the femoral vein due
to intrahepatic interruption of IVC. We performed a modified surgical
bipolar radiofrequency ablation (RF) on the beating heart through 3
ports in the left chest wall. Pulmonary vein isolation and ablation of
the left atrium were achieved by bipolar radiofrequency ablation.
Ganglionic plexus ablation was completed using the ablation pen. The
left atrial appendage was excluded. No complications occurred during or
after the procedure. The patient was discharged with sinus rhythm 3 days
later after the procedure. She was taking amiodarone (100mg bid) within
6 months after the procedure, and had no recurrence of AF. Conclusions:
We successfully performed a modified mini-maze procedure in a patient
with paroxysmal AF and IVC interruption through the left thoracic cavity
under video-assisted thoracoscopic surgery (VATS). We can successfully
complete pulmonary vein (PV) isolation, left atrium box isolation,
cardiac ganglia ablation, Marshall ligament ablation, and coronary sinus
epicardium ablation using this technique.