Bipolar Irrigated Radiofrequency Ablation of the Posterior-Inferior Left Atrium and Coronary Sinus is Feasible and Safe
DOI:
https://doi.org/10.1532/HSF98.20041094Abstract
Background: Success of surgical therapy for atrial fibrillation (AF) mainly depends on creating a complete set of transmural atrial lesions. The established Cox procedures may be simplified by dropping lesions, but not without the risk of impaired results. We aimed to create a complete set of lesions using bipolar irrigated radiofrequency including ablation of the posterior-inferior left atrium (LA) and coronary sinus. Feasibility and safety were investigated.
Methods: Six patients (mean age 63 ± 14 years) with continuous AF (duration 15 ± 8 months) underwent elective heart surgery for isolated mitral valve procedures (n = 4), in combination with myocardial revascularization (n = 1) or isolated bypass surgery (n = 1). Ablation of AF was performed using bipolar irrigated radiofrequency to create a modified Cox minimaze pattern.
Results: No major intraoperative or postoperative complication occurred. Two patients left the operating room in sinus rhythm and 4 in junctional rhythm with atrioventricular pacing. AF ablation required 20 ± 5 minutes. Conclusions: Bipolar irrigated radiofrequency ablation including ablation of the posterior-inferior LA and coronary sinus is feasible and can be performed safety. Long-term studies in large patient cohorts are necessary to show efficiency of this method.
References
Sie HT, Beukema WP, Elvan A, Misier ARR. 2004. Long-term results of irrigated radiofrequency modified maze procedure in 200 patients with concomitant cardiac surgery: six years experience. Ann Thorac Surg 77:512-7.nGaita F, Riccardi R, Gallotti R. 2002. Surgical approaches to atrial fibrillation. Cardiac Electrophysiol Rev 6:401-5.nGüden M, Akpinar B, Sanisoglu I, Sagbas E, Bayindir O. 2002. Intraoperative saline-irrigated radiofrequency modified maze procedure for atrial fibrillation. Ann Thorac Surg 74:S1301-6.nKawaguchi AT, Kosakai Y, Sasako Y, et al. 1996. Risks and benefits of combined Maze procedure for atrial fibrillation associated with organic heart disease. J Am Coll Cardiol 1996;28:985-90.nKim K-B, Huh J-H, Kang CH, Ahn H, Sohn D-W. 2001. Modifications of the Cox-maze III procedure. Ann Thorac Surg 71:816-22.nNitta T, Lee R, Schuessler RB, Boineau JP, Cox JL. 1999. Radial approach: A new concept in surgical treatment for atrial fibrillation, I: concept, anatomic and physiologic basis and development of a procedure. Ann Thorac Surg 67:27-35.nPrasad SM, Maniar HS, Schuessler RB, Damiano RJ. 2002. Chronic transmural atrial ablation by using bipolar radiofrequency energy on the beating heart. J Thorac Cardiovasc Surg 124:708-13.nBonanomi G, Schwartzman D, Francischelli D, Hebsgaard K, Zenati MA. 2003. A new device for beating heart bipolar radiofrequency atrial ablation. J Thorac Cardiovasc Surg 126:1859-66.nCox JL. 1991. The surgical treatment of atrial fibrillation. J Thorac Cardiovasc Surg 101:584-92.nCox JL, Jaquiss RDB, Schuessler RB, Boineau JP. 1995. Modification of the maze procedure for atrial flutter and atrial fibrillation; II, surgical technique of the maze III procedure. J Thorac Cardiovasc Surg 110:485-95.nCox Jl, Ad N. 2000. The importance of cryoablation of the coronary sinus during the maze procedure. Semin Thorac Cardiovasc Surg 12:20-4.nCox JL. 2003. Atrial fibrillation II: rationale for surgical treatment. J Thorac Cardiovasc Surg 126:1693-9.nDoll N, Meyer R, Walther T, Mohr FW. 2004. A new cryoprobe for intraoperative ablation of atrial fibrillation. Ann Thorac Surg 77:1460-2.n
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