Cited 2 times since 2019 (2.1 per year) source: Scopus The Journal of thoracic and cardiovascular surgery, Volume 160, Issue 2, 28 August 2019, Pages 399-405 Clamping versus nonclamping thoracoscopic box ablation in long-standing persistent atrial fibrillation. Harlaar N, Verberkmoes NJ, van der Voort PH, Trines SA, Verstraeten SE, Mertens BJA, Klautz RJM, Braun J, van Brakel TJ


To compare clinical outcomes of clamping devices and linear nonclamping devices for isolation of the posterior left atrium (box) in thoracoscopic ablation of long-standing persistent atrial fibrillation.


Eighty patients who underwent thoracoscopic pulmonary vein and box isolation using a bipolar clamping device (42 patients) or bipolar nonclamping device (38 patients) to create the roof/inferior lesions for box isolation were included from 2 centers. Follow-up consisted of 24-hour Holter at regular intervals. Freedom from AF during 1-year follow-up and catheter repeat interventions were compared between groups.


Acute intraoperative electrical isolation of the box compartment was significantly higher in the clamping group than in the nonclamping group (100% and 79%, respectively, P < .01). At 1-year follow-up, 91% of the clamping group and 79% of the nonclamping group were in sinus rhythm. During 1-year follow-up, recurrence rates did not significantly differ between the 2 groups (P = .08). Repeat catheter interventions were required in 10% of the clamping group and 21% of the nonclamping group (P = .15). Conduction gaps in the roof or inferior lesions were found in 1 patient (2%) in the clamping group versus 4 patients (11%) in the nonclamping group (P = .13).


Thoracoscopic pulmonary vein and box isolation are highly effective in restoring sinus rhythm in long-standing persistent atrial fibrillation on short-term follow-up. Comparison of clamping and nonclamping devices revealed lower rates of intraoperative exit block of the box in the nonclamping group. However, this did not translate into a significant difference in atrial fibrillation freedom at short-term (1-year) follow-up.

Keywords: Surgery, Atrial fibrillation, Ablation, Thoracoscopy, Clamping, Box-lesion

J Thorac Cardiovasc Surg. 2019 Aug;160(2):399-405