Thoracoscopic Surgical Versus Catheter Ablation Approaches for Primary Treatment of Persistent Atrial Fibrillation

Exclusion Criteria

• •Prior intervention (catheter ablation or minimally-invasive thoracoscopic ablation) for AF.
• •AF is secondary to electrolyte imbalance, thyroid disease or other reversible or non-cardiovascular causes.
• •Documentation of CTI dependent atrial flutter
• •Valvular AF
• •Paroxysmal AF
• •Long standing Persistent AF, defined as AF continuously present for longer than 1 year.
• •Body mass index \>35kg/m2
• •NYHA class IV heart failure symptoms or left ventricular ejection fraction \<35%.
• •NYHA class III heart failure symptoms, unless caused or aggravated by AF.
• •Myocardial infarction within the preceding 2 months.
• •Active infection or sepsis (as evidenced by increased white blood cell count, elevated CRP level or fever \>38,5 °C).
• •Known and documented carotid stenosis \> 80%
• •Planned cardiac surgery for other purposes than AF.
• •Pregnancy or child bearing potential without adequate anticonception.
• •Requirement of anti-arrhythmic drugs for ventricular arrhythmias.
• •Presence of intracardiac mass or thrombus (discovery of any thrombus or intracardiac mass after signing of the informed consent will result in withdrawal of the subject from the study)
• •Co-morbid condition that possesses undue risk of general anesthesia or port access cardiac surgery (in the opinion of the operator).
• •History of previous radiation therapy on the thorax
• •Circumstances that prevent follow-up
• •No vascular access for catheterization.
• •History of previous thoracotomy.
• •Factors precluding transseptal puncture for catheterization.