This syposium focussed mainly on the non pharmacological treatment of AF, with discussions on what should be the repective parts of catheter and surgery ablation.
1) HJGM Crijns (Maastritcht, NL) began the session in a provocative way saying, “Lone AF does not exist”. Actually, there is almost always an associated risk factor such as hypertension which is frequently associated with AF. Furthermore, the electrical and anatomic remodelling soon appears. Analysis of the follow-up of AF patients leads to distinguish two groups of “Lone AF”; those with a stable left atrial size, and those with an increased LA size (with the poorest outcome). It could be this subgroup of patients who could benefit the most from the radiofrequency catheter ablation.
2) F Extramania (Paris, FR) presented the ablative techniques (anatomic or functionnal approach) which are different from one center to another, leading to different quality sets of results. 70 % to 90% of stable sinus rythme in 1 year. The quality of the evaluation of the results at the end of the procedure seems to be a determinant factor to the success rate. This indication is also determimant, and H Crijns says this during the discussion,that due to its poor results - permanent AF should not be an indication for catheter ablation.
3) J Queiroz E Melo (Carnaxide, PT) reported on the evolution of the surgical treatment of AF, starting with the Maze procedure. The Maze is still the gold standard, even if it is no longer used, due to the complexity of the technique. He admits that surgeons have a poor experience of “lone AF” since the majority of the surgical data available are from a series of mitral valve patients. Nevertheless, the new devices allow for simplification of the original Maze, and it is now possible to get good results; > 70 % of recurrence of stable SR, even in those more sever AF, with a significant proportion of permanent AF. He points out that after catheter ablation there is at least 20% of failure and he calls on cardiologist to be logical, and to refer those patients to surgery, which is not the case at the moment. In conclusion, he believes that surgery shoud be concentrated on the most severe patients, for example, stroke patients.
4) C Muneretto (Brescia, IT) reported on his original experience of a really mini-invasive technique, without general anesthesia, video-assisted, lasting less than one hour, and allowing for the discharge of the patients on day 2. He recently performed an encircling of the 4 pulmonary veins, through a single right side approach (peridural anesthesia), without exclusion of the left atrial appendage. His results, among the first 37 patients, are almost perfect without no complications at all, and with a satisfactory SR conversion of more than 80%. These promising results have to be confirmed on a larger scale.