Transabdominal Endoscopic Pericardial Access for Epicardial Ablation

Epicardial cardiac ablation (MAZE procedure) and endocardial (percutaneous catheter based) ablation are well described techniques in the treatment of atrial fibrillation. A novel procedure recently developed is the hybrid mini-maze (convergent MAZE procedure) that involves a concurrent transabdominal endoscopic epicardial MAZE and endocardial catheter based ablation. The MAZE procedure has classically involved either a sternotomy or thoracotomy. Few case references are made of transabdominal endoscopic cardiac access. Here we present a cases series involving transabdominal endoscopic cardiac access for epicardial cardiac ablation during hybrid mini-maze procedure. Using retrospective single institution analysis of 53 patients undergoing hybrid mini-maze procedure we were able demonstrate safety and technical feasibility of SUBTLE (sub-thoracic, totally endoscopic) pericardial access. Of the 53 patients who underwent the procedure 1 required conversion to sternotomy for perforation of atrial appendage during endocardial ablation, 1 developed tamponade post-op relieved by a pericardial window, and 82% of patients remained in sinus rythem as of December 2011 (1 to 30 months follow up). All patients even those with prior abdominal surgery and inflammatory processes have undergone successful SUBTLE access without complication related to access. While further study is necessary to evaluate the efficacy of hybrid mini-maze procedure versus standard MAZE procedure or endocardial ablation alone; we have demonstrated technical feasibility and safety of transabdominal endoscopic pericardial access.

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