Right mini-thoracotomy for left maze with transesophageal echo guidance

Minimally invasive surgery (MIS) is widening with the development of new specialized instrumentation, allied with improved surgical experience and techniques, some of which have shown to be effective for the ablation of atrial fibrillation (AF). These developments enable us to achieve a so-called ‘ideal procedure’, epicardially on beating hearts, with less operative risk, high cure rates and rapid patient recovery. Epicor (St Jude Medical, Sunnyvale, CA, USA) low profile (LP) system is a device using high intensity focused ultrasound (HIFU). We describe the use of this technology for ablation of AF through MIS approach using transesophageal echocardiography (TEE) to pilot the ablation on mitral isthmus. Ten patients underwent monolateral small thoracotomy, through the 4th intercostal space. HIFU was carried out in all cases to create an epicardial box lesion of the pulmonary veins (PVs) and mitral isthmus. TEE was employed to guide the positioning of the ablation device on mitral isthmus, in all patients. There were no mortalities or major complications, including pacemaker implantation. One patient had postoperative atrial tachycardia and was cardioverted before hospital discharge. Three patients had a postoperative AF and were scheduled for cardioversion after three months, and one patient spontaneously revealed a normal sinus rhythm (SR). During the follow-up period, all patients recorded a normal SR. We consider Epicor LP system safe and effective for AF ablation through a single right minimal invasive approach.