Approaching a Paradigm Shift: Endoscopic Ablation of Lone Atrial Fibrillation on the Beating Heart Timo Weimar, MD, Martina Vosseler, RN, Markus Czesla,

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Approaching a Paradigm Shift: Endoscopic Ablation of Lone Atrial Fibrillation on the Beating Heart Timo Weimar, MD, Martina Vosseler, RN, Markus Czesla, MD, Margaretha Boscheinen, MD, Wolfgang B. Hemmer, MD, Kai-Nicolas Doll, MD The Annals of Thoracic Surgery Volume 94, Issue 6, Pages 1886-1892 (December 2012) DOI: 10.1016/j.athoracsur.2012.07.035 Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Left atrial lesion set including pulmonary vein isolation, a roof line and bottom line, a trigonal line to the aortic noncoronary sinus, and resection of the left atrial appendage (dashed line). The Annals of Thoracic Surgery 2012 94, 1886-1892DOI: (10.1016/j.athoracsur.2012.07.035) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Port placement for thoracoscopic access on the right side of the chest. The Annals of Thoracic Surgery 2012 94, 1886-1892DOI: (10.1016/j.athoracsur.2012.07.035) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Thoracoscopic view. (A) Isolation of the right pulmonary veins with a bipolar radiofrequency clamp. (B) Resection of the left atrial appendage. The Annals of Thoracic Surgery 2012 94, 1886-1892DOI: (10.1016/j.athoracsur.2012.07.035) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Mapping of the trigonal line: a conductance delay between sensing point A and sensing point B when pacing at point C confirmed isolation. The Annals of Thoracic Surgery 2012 94, 1886-1892DOI: (10.1016/j.athoracsur.2012.07.035) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Overall freedom from atrial fibrillation (AF) and freedom from AF without antiarrhythmic agents at follow-up. The Annals of Thoracic Surgery 2012 94, 1886-1892DOI: (10.1016/j.athoracsur.2012.07.035) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Success rates for different types of atrial fibrillation (AF). The Annals of Thoracic Surgery 2012 94, 1886-1892DOI: (10.1016/j.athoracsur.2012.07.035) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions

Fig 7 (A) Changes in quality of life at 12 months compared with baseline. * p ≤ 0.001. (B) Postoperative quality of life with and without antiarrhythmic agents. *p ≤ 0.001. (BP = body pain; GH = general health; MCS = mental component summary; MH = mental health; PCS = physical component summary; PF = physical functioning; RP = role physical; RE = role emotional; SF = social functioning; VT = vitality.) The Annals of Thoracic Surgery 2012 94, 1886-1892DOI: (10.1016/j.athoracsur.2012.07.035) Copyright © 2012 The Society of Thoracic Surgeons Terms and Conditions