Bipolar Radiofrequency to Ablate Atrial Fibrillation in Patients Undergoing Mitral Valve Surgery
Background: Atrial fibrillation (AF) affects 30% to 50% of patients undergoing mitral valve surgery. The optimum treatment of AF in these patients is unclear. The purpose of this study was to describe initial clinical experience using a bipolar radiofrequency clamp to facilitate AF ablation in patients undergoing mitral valve surgery.
Methods: From November 2001 through March 2003 a bipolar radiofrequency clamp was used to facilitate AF ablation in 108 patients undergoing mitral valve surgery. Preoperative AF was paroxysmal in 25%, persistent in 26%, and permanent in 49% of the patients. All patients underwent bilateral pulmonary vein isolation performed with the bipolar radiofrequency clamp and excision or exclusion of the left atrial appendage. Most patients had connecting lesions between the right and left pulmonary veins and between the left atrial appendage and the left pulmonary veins. Novel statistical methods were used to create a plot of the prevalence of AF versus time after surgery.
Results: Mean time required for AF ablation was 17 ± 4 minutes (range, 9-28 minutes). All patients left the operating room with sinus rhythm or with atrial or atrioventricular pacing for an underlying nodal rhythm. Perioperative AF was common, affecting 64% of patients. At discharge, 33% of patients were in AF or atrial flutter. By 3 months postoperatively, the predicted prevalence of AF or atrial flutter was 15%. There were no device-related complications.
Conclusions: Bipolar radiofrequency facilitates rapid and safe AF ablation in patients with mitral valve disease. Perioperative AF is common and should be treated aggressively. By 3 months postoperatively, 85% of patients are free of AF or atrial flutter. Continued follow-up is necessary to document late results of this strategy.
Bando K, Kobayashi J, Kosakai Y, et al. 2002. Impact of Cox maze procedure on outcome in patients with atrial fibrillation and mitral valve disease. J Thorac Cardiovasc Surg 124:575-83.nBlackstone EH, Naftel DC, Turner ME Jr. 1986. The decomposition of time-varying hazard into phases, each incorporating a separate stream of concomitant information. J Am Stat Assoc 81:615-24.nChen SA, Hsieh MS, Tai CT, et al. 1999. Initiation of atrial fibrillationby ectopic beats originating from the pulmonary veins: electrophysiological characteristics, pharmacological responses, and effects of radiofrequency ablation. Circulation 100:1879-86.nCox JL. 2001. Intraoperative options for treating atrial fibrillation associated with mitral valve disease. J Thorac Cardiovasc Surg 122:212-5.nCox JL, Ad N. 2000. New surgical and catheter-based modifications of the maze procedure. Semin Thorac Cardiovasc Surg 12:68-73.nCox JL, Ad N, Palazzo T, et al. 2000. Current status of the maze procedure for the treatment of atrial fibrillation. Semin Thorac Cardiovasc Surg 12:15-9.nDamiano RJ Jr. 2003. Alternative energy sources for atrial ablation: judging the new technology. Ann Thorac Surg 75:329-30.nGillinov AM, Blackstone EH, McCarthy PM. 2002. Atrial fibrillation: current surgical options and their assessment. Ann Thorac Surg 74:2210-7.nGillinov AM, McCarthy PM. 2002. AtriCure bipolar radiofrequency clamp for intraoperative ablation of atrial fibrillation. Ann Thorac Surg 74:2165-8.nGillinov AM, McCarthy PM, Marrouche N, Natale A. 2003. Contemporary surgical treatment for atrial fibrillation. Pacing Clin Electrophysiol 26:1641-4.nGillinov AM, Pettersson G, Rice TW. 2001. Esophageal injury during radiofrequency ablation for atrial fibrillation. J Thorac Cardiovasc Surg 122:1239-40.nHaissaguerre M, Jais P, Shah DC, et al. 1998. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 339:659-66.nPrasad SM, Maniar HS, Schuessler RB, Damiano RJ Jr. 2002. Chronic transmural atrial ablation by using bipolar radiofrequency energy on the beating heart. J Thorac Cardiovasc Surg 124:708-13.nSchaff HV, Dearani JA, Daly RC, Orszulak TA, Danielson GK. 2000. Cox-maze procedure for atrial fibrillation: Mayo Clinic experience. Semin Thorac Cardiovasc Surg 12:30-7.nSie HT, Beukema WP, Ramdat Misier AR, et al. 2001. Radiofrequency modified maze in patients with atrial fibrillation undergoing concomitant cardiac surgery. J Thorac Cardiovasc Surg 122:249-56.nSra J, Dhala A, Blanck Z, Deshpande S, Cooley R, Akhtar M. 2000. Atrial fibrillation: epidemiology, mechanisms, and management. Curr Probl Cardiol 25:405-524.nWilliams MR, Stewart JR, Bolling SF, et al. 2001. Surgical treatment of atrial fibrillation using radiofrequency energy. Ann Thorac Surg 71:1939-44.nHanda N, Schaff HV, Morris JJ, Anderson BJ, Kopecky SL, Enriquez-Sarano M. 1999. Outcome of valve repair and the Cox maze procedure for mitral regurgitation and associated atrial fibrillation. J Thorac Cardiovasc Surg 118:628-35.nKottkamp H, Hindricks G, Autschbach R, et al. 2002. Specific linear left atrial lesions in atrial fibrillation. J Am Coll Cardiol 40:475-80.nKress DC, Krum D, Chekanov V, et al. 2002. Validation of left atrial lesion pattern for intraoperative ablation of atrial fibrillation. Ann Thorac Surg 73:1160-8.nLickfett LM, Calkins HG, Berger RD. 2002. Radiofrequency ablation for atrial fibrillation. Curr Treat Options Cardiovasc Med 4:295-306.nMcCarthy PM, Gillinov AM, Castle L, Chung M, Cosgrove DM III. 2000. The Cox-maze procedure: the Cleveland Clinic experience. Semin Thorac Cardiovasc Surg 12:25-9.nPasic M, Bergs P, Muller P, et al. 2001. Intraoperative radiofrequency maze ablation for atrial fibrillation: the Berlin modification. Ann Thorac Surg 72:1484-91.n
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