What is atrial fibrillation? Human life is maintained by the normal beating of the heart: the heart takes back the used blood (oxygen has been applied) from the whole body, pumps it to the lungs and brings oxygen into the bloodstream by breathing, while expelling carbon dioxide, and then sends the oxygenated blood to the whole body again, which is the main function of the heart. The structure of the heart is like a two-story house with four rooms, the lower “room” we call the ventricle and the upper two “rooms” are called the atria (the right atrium on the right and the left atrium on the left). The right atrium has a special tissue called the sinoatrial node, which is the “command” that controls the entire heartbeat and distributes bioelectricity in a regular and neat manner to control the heartbeat. A normal heartbeat is between 60 and 100 beats per minute, with a regular rhythm and coordinated contractions of the atria and ventricles, known as sinus rhythm. In some cases, when a part of the left atrium or pulmonary vein emits another “fibrillating” bioelectricity, which is fast and chaotic, causing the atria to contract at a rate of 300 to 600 beats per minute, this is called atrial fibrillation. When atrial fibrillation occurs, the sinus node loses control. Atrial fibrillation causes loss of atrial function and also causes fast and irregular beating of the ventricles and a significant decrease in ventricular blood supply, which in turn causes insufficient blood supply to the brain and other organs of the body. The incidence of atrial fibrillation in the population is about 0.5%, but the incidence increases significantly with age and can be as high as 6% in people over 60 years of age. Atrial fibrillation can cause discomfort in mild cases, or in severe cases, heart failure, loss of labor force, or even life-threatening cerebral thromboembolism. Patients with atrial fibrillation have palpitations, shortness of breath, fatigue, dizziness and other obvious discomfort, mainly because: 1, the heart beat is sometimes strong and sometimes weak, when the heart rate is too fast and too slow and serious arrhythmia, the patient can obviously feel the heart beating sensation and palpitations. 2. When the cardiac output is reduced during arrhythmia, the blood supply to the brain is affected and the patient may feel dizzy. 3, fatigue, shortness of breath: this is mainly due to the patient’s reduced heart function. The heart function of patients with atrial fibrillation is reduced by about 20% – 30%, and the patient’s symptoms may worsen or even heart failure may occur. Atrial fibrillation can also bring about a serious complication – a stroke. Atrial fibrillation is highly susceptible to atrial thrombosis. The thrombus is basically located in the left atrium, which can easily dislodge and lead to stroke, heart and kidney infarction and other important organs. According to statistics, the prevalence of stroke in patients with atrial fibrillation is 6 ~ 8 times higher than that of non-atrial fibrillation population, up to 13.9%. Atrial fibrillation is one of the serious health hazards and an important cause of death and disability in middle-aged and elderly people. The consequences of stroke due to atrial fibrillation are severe and are associated with high mortality and paralysis rates, with a 50% chance of death in a year. In addition, patients with atrial fibrillation can cause sudden death due to ventricular fibrillation, so the mortality rate of patients with atrial fibrillation is two to four times higher than normal. This is because the bioelectric frequency of atrial fibrillation is in the range of 300 ~ 600 beats per minute, and if it travels 1:1 to the ventricles, then ventricular fibrillation will occur and the patient will die suddenly. The technique, effectiveness and safety of the ultra-minimally invasive surgical treatment of atrial fibrillation “May’s ultra-minimally invasive” surgical treatment of atrial fibrillation is a complete ablation procedure performed under full thoracoscopy with three small 1 ~ 2 cm holes in the lateral posterior aspect of the left chest wall. First, the ablation line of pulmonary vein isolation is continuous, through the wall, and complete, with a high success rate; second, minimally invasive surgical treatment can remove the most thrombus-prone left auricle intraoperatively, greatly reducing the risk of thrombosis and embolism due to atrial fibrillation; third, epicardial autonomic ganglion, marshell ligament, and other major factors for the development of atrial fibrillation can be removed simultaneously during the procedure; fourth, electrophysiological markers can be performed intraoperatively. Fourth, electrophysiological markers can be performed during the procedure to evaluate the effect in a timely manner; fifth, the procedure can be completed in about two hours, and neither the doctor nor the patient needs to experience prolonged X-ray exposure during catheter ablation, and there is no radiological damage and no possibility of kidney damage from contrast agents. In the past five years, the ultra-minimally invasive technique for atrial fibrillation has become very mature and the procedure is very safe. In a statistical analysis of more than 500 recent postoperative patients, none of them had any related complications; the efficacy of the procedure is also ideal, with a single success rate of 93%. Long-term follow-up results show that the long-term results are basically the same for both paroxysmal and persistent atrial fibrillation. For atrial fibrillation that recurs after interventional treatment, the ultra-minimally invasive technique for atrial fibrillation can achieve better results. This technique was published in the top international professional journals and was unanimously recognized by domestic and international experts, and won the 2013 “Minimally Invasive Cardiothoracic Surgery” Best Technology Innovation Award. Superiority of minimally invasive surgical treatment of atrial fibrillation Atrial fibrillation, as a heart disease, can exist alone (isolated atrial fibrillation) or as a complication of other diseases. The goals of treatment for atrial fibrillation: prevention of thromboembolism and restoration of normal sinus rhythm, without medication or with reduced drug dependence. Compared with traditional treatment methods, ultramicroinvasive surgical treatment of atrial fibrillation has its unique superiority: 1. High surgical success rate: The single surgical success rate of ultramicroinvasive surgical treatment of atrial fibrillation is over 93%. The procedure is able to complete perfect ablation lines of atrial fibrillation, and these ablation lines are continuous, transmural and complete, which is the best technique in the international arena, and thus its postoperative efficacy is also the best. Continuous and wall-permeable ablation is crucial. If the ablation is not wall-permeable and continuous, the bioelectricity will be easily retransmitted, resulting in the recurrence of AF. The success rate of the interventional treatment of atrial fibrillation carried out by the Department of Cardiology is mostly between 30 and 70%, and it is easy to recur because the ablation line does not penetrate the wall and is not continuous.2. Avoiding the possibility of thrombosis of the left heart ear and stroke: Minimally invasive surgical treatment of atrial fibrillation can remove the left heart ear, thus eliminating the possibility of stroke. Even if atrial fibrillation recurs in the future, the patient will not suffer from thrombosis and stroke because the left heart ear is removed, whereas traditional treatment methods cannot remove the left heart ear, and because of the high recurrence rate, there is still a risk of thrombosis and stroke when atrial fibrillation recurs. 3, small trauma: minimally invasive surgical treatment of atrial fibrillation is done under full thoracoscopy, so the surgery is very traumatic, with only three small incisions of 1~2cm on the body surface, and hidden. The incision is very large and the length is more than 5cm. 4, less complications and shorter hospital stay: The surgery is performed under full thoracoscope, with high clarity and less intraoperative complications. The surgery is less traumatic and can be completed in about 2 hours, while the surgery time is short and the hospital stay is also short, usually about 5 days after surgery. 5, do not have to bear the damage of X-ray irradiation: the whole surgery time is short, the patient sleeps after the surgery has been completed, compared with the intervention patients avoid a long time of X-ray irradiation. Which patients with atrial fibrillation are suitable for minimally invasive surgery? Minimally invasive surgery for atrial fibrillation is suitable for individual patients with atrial fibrillation, such as paroxysmal atrial fibrillation with frequent episodes and severe symptoms; persistent or chronic atrial fibrillation with severe symptoms; atrial fibrillation with no symptoms but with thromboembolic risk factors. In conclusion, minimally invasive surgery is suitable for the majority of patients with atrial fibrillation. Some patients with atrial fibrillation have no obvious symptoms and are only detected when serious complications of atrial fibrillation, such as stroke, occur. In this case, the treatment should not be a headache or a foot injury, but the treatment of atrial fibrillation should also be carried out simultaneously. In patients who have had a stroke, attention should be paid to whether or not atrial fibrillation has occurred in combination. According to statistics, the prevalence of stroke in patients with atrial fibrillation is 6 to 8 times higher than that of non-atrial fibrillation patients, up to 13.9%. Early intervention of atrial fibrillation and its symptoms can significantly reduce the incidence of stroke. Patients with persistent atrial fibrillation have obvious symptoms when they first develop atrial fibrillation, but often the patient’s self-conscious symptoms instead diminish or disappear as the disease progresses. Therefore, it is important to note here that the symptoms of atrial fibrillation are often ignored by the patient’s perception or sensitivity or tolerance, so it is important not to take it lightly. Patients diagnosed with atrial fibrillation can be treated with medication first, but its effect is relatively poor; interventional radiofrequency ablation for atrial fibrillation has achieved some results in recent years, but due to the limitations of its technical approach, the success rate is low and most patients have to undergo multiple radiofrequency ablation, which is also expensive. Surgical ultra-minimally invasive treatment of atrial fibrillation avoids highly invasive and high-risk open-heart surgery, greatly reduces surgical trauma and pain, and the surgical incision is small and concealed with fast postoperative recovery. The ablation line can be precise, penetrating and complete during the surgical treatment, and the main factors for the development of AF, such as epicardial autonomic ganglion and marshell ligament, can be removed at the same time during the surgery. Surgical treatment also allows for the intraoperative removal of the left auricle, which is most susceptible to thrombus formation, greatly reducing the risk of thrombosis and embolism due to atrial fibrillation after surgery. Minimally invasive surgical treatment of atrial fibrillation combined with heart valve disease With the continuous development and improvement of new technologies for the surgical treatment of atrial fibrillation in China, there are now effective minimally invasive surgical treatment techniques for patients with atrial fibrillation combined with other heart diseases, such as heart valve disease, coronary artery disease, and precordial disease combined with atrial fibrillation, which are now also being treated with minimally invasive surgical techniques in conjunction with valve replacement surgery, heart bypass surgery, and radical surgery for precordial disease The treatment of atrial fibrillation is now mature, and the effect can reach more than 98%. Therefore, patients with atrial fibrillation combined with other heart diseases do not have to worry about being unable to be treated, as minimally invasive surgery can also be used to achieve good results. Pre- and post-operative considerations for minimally invasive surgical treatment of atrial fibrillation In general, patients with atrial fibrillation need to stop smoking, limit alcohol consumption, and avoid caffeine-containing substances such as tea, coffee, cola, and some over-the-counter medications before surgery. Patients with atrial fibrillation alone will need to take cortisone and warfarin for three months after surgery to reinforce the results of the procedure, after which they can stop taking any medication. According to the statistics, after the ultra-minimally invasive surgical procedure for atrial fibrillation, because the left heart ear has been removed and warfarin was discontinued after three months, no stroke was found and the effect of stroke prevention was achieved. In contrast, for patients undergoing heart valve replacement and heart bypass surgery, postoperative anticoagulation therapy and regular follow-up visits to the hospital and physician may be required.