Off-Pump Epicardial Atrial Fibrillation Surgery Utilizing a Novel Bipolar Radiofrequency System

Authors

  • Deon W. Vigilance
  • Mauricio Garrido
  • Mathew Williams
  • Elaine Wan
  • Ann Zeidner
  • Jennifer Casher
  • Aftab Kherani
  • Jeffrey Morgan
  • Yoshifumi Naka
  • Craig Smith
  • Mehmet C. Oz
  • Michael Argenziano

DOI:

https://doi.org/10.1532/HSF98.20061019

Abstract

Background. Over the past several years, pulmonary vein isolation for the treatment of atrial fibrillation has gained significant popularity. This study was undertaken to evaluate a novel radiofrequency (RF)-enabled clamp system designed to create transmural lesions epicardially on the beating heart using bipolar RF.

Methods. A set of differently shaped clamps modified to deliver bipolar RF energy were used to create a series of lesions in a beating heart canine model. The pulmonary veins and atrial appendages of 6 dogs were electrically isolated using bipolar RF energy. The right and left atrial appendages served as controls for the right and left pulmonary veins, respectively. Temperature-controlled RF energy was delivered to maintain a tissue temperature of 80°C for 15 seconds. Electrical isolation was assessed acutely and after 4 weeks by a bipolar pacing protocol.

Results. A total of 24 circumferential lesions were created. By pacing analysis, 100% (24/24) of these lesions were electrically isolated acutely and 95% (19/20) were still isolated 4 weeks later. At 4 weeks, 92% (22/24) of lesions were transmural by histologic analysis, and 96% (23/24) demonstrated endocardial continuity. One animal experienced a fatal cardiac arrhythmia during initiation of the post-survival procedure, prior to electrophysiologic evaluation, accounting for the reduced number of potential electrically isolated lesions.

Conclusion. Bipolar RF ablation utilizing a novel bipolar RF clamp device results in electrical isolation and histologic transmurality in an off-pump epicardial model.

References

Allessie MA, Bonke FI. 1985. Experimental evaluation of Moe's multiple wavelet hypothesis of atrial fibrillation. In: D Zipes JJ, ed. Cardiac Electrophysiology and Arrhythmias. New York: Grune & Stratton, 265-275.nCox JL. 1991. The surgical treatment of atrial fibrillation. IV. Surgical technique. J Thorac Cardiovasc Surg 101:584-92.nCox JL, Canavan TE, Schuessler RB, et al. 1991. The surgical treatment of atrial fibrillation. II. Intraoperative electrophysiologic mapping and description of the electrophysiologic basis of atrial flutter and atrial fibrillation. J Thorac Cardiovasc Surg 101:406-26.nCox JL, Schuessler RB, Boineau JP. 2000. The development of the Maze procedure for the treatment of atrial fibrillation. Semin Thorac Cardiovasc Surg 12:2-14.nCox JL, Schuessler RB, Boineau JP. 1991. The surgical treatment of atrial fibrillation. I. Summary of the current concepts of the mechanisms of atrial flutter and atrial fibrillation. J Thorac Cardiovasc Surg 101:402-5.nCox JL, Schuessler RB, D'Agostino HJ Jr, et al. 1991. The surgical treatment of atrial fibrillation. III. Development of a definitive surgical procedure. J Thorac Cardiovasc Surg 101:569-83.nCox JL, Schuessler RB, Lappas DG, et al. 1996. An 81/2-year clinical experience with surgery for atrial fibrillation. Ann Surg 224:267-73.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.nHealth Care Finance Administration Annual Report, 1997. From: Prasad SM, Maniar HS, Schuessler RB, et al. 2002. Chronic transmural atrial ablation by using bipolar radiofrequency energy on the beating heart. J Thorac Cardiovasc Surg 124:708-13.nJalife J, Berenfeld O, Skanes A, et al. 1998. Mechanisms of atrial fibrillation: mother rotors or multiple daughter wavelets, or both? J Cardiovasc Electrophysiol 9(8 suppl):S2-12.nLonnerholm S, Blomstrom P, Nilsson L, et al. 2002. Atrial size and transport function after the Maze III procedure for paroxysmal atrial fibrillation. Ann Thorac Surg 73:107-11.nMoe GK, Abildskov JA. 1959. Atrial fibrillation as a self-sustaining arrhythmia independent of focal discharge. Am Heart J 58:59-70.nMoe GK, Rheinboldt WC, Abildskov JA. 1964. A computer model of atrial fibrillation. Am Heart J 67:200-20.nPrasad SM, Maniar HS, Schuessler RB, et al. 2002. Chronic transmural atrial ablation by using bipolar radiofrequency energy on the beating heart. J Thorac Cardiovasc Surg 124:708-13.nScherlag BJ, Yamanashi WS, Schauerte P, et al. 2002. Endovascular stimulation within the left pulmonary artery to induce slowing of heart rate and paroxysmal atrial fibrillation. Cardiovasc Res 54:470-5.nWyse DG, Waldo AL, DiMarco JP, et al. 2002. A comparison of rate control and rhythm control in patients with atrial fibrillation. N Engl J Med 347:1825-33.nZimmer J, Pezzullo J, Choucair W, et al. 2003. Meta-analysis of antiarrhythmic therapy in the prevention of postoperative atrial fibrillation and the effect on hospital length of stay, costs, cerebrovascular accidents, and mortality in patients undergoing cardiac surgery. Am J Cardiol 91:1137-40.n

Published

2006-08-07

How to Cite

Vigilance, D. W., Garrido, M., Williams, M., Wan, E., Zeidner, A., Casher, J., Kherani, A., Morgan, J., Naka, Y., Smith, C., Oz, M. C., & Argenziano, M. (2006). Off-Pump Epicardial Atrial Fibrillation Surgery Utilizing a Novel Bipolar Radiofrequency System. The Heart Surgery Forum, 9(5), E803-E806. https://doi.org/10.1532/HSF98.20061019

Issue

Section

Articles

Most read articles by the same author(s)

1 2 > >>