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Surgical treatment of permanent atrial fibrillation during cardiac surgery using monopolar and bipolar radiofrequency ablation

Geidel, Stephan and Ostermeyer, Jörg and Lass, Michael and Boczor, Sigrid and Kuck, Karl-Heinz (2003) Surgical treatment of permanent atrial fibrillation during cardiac surgery using monopolar and bipolar radiofrequency ablation. [Journal (Paginated)]

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Abstract

Objective: Permanent atrial fibrillation (pAF) is a serious problem in cardiac surgery: An incidence of 3.5% among all patients scheduled for open heart surgery, 9.8% in heart valve cases and 45.6% among patients with severe rheumatic mitral valve (MV) disease was observed in our institution. Our experience with radiofrequency (RF) ablation procedures to treat pAF in these cases is reported. Methods: Since February 2001 monopolar endocardial RF ablation procedures creating two encircling isolation lesions around the left and the right pulmonary veins (LPVs, RPVs) and a connection line between both were performed in patients with pAF concomitant to heart valve surgery. Since March 2003 bipolar RF ablation was used as an adjunct to CABG surgery. Amiodarone was given for 3 months after surgery. Results: Sixtytwo patients with pAF underwent surgical ablation procedures and primary valve (mitral: n=45; aortic: n=13; aortic+mitral: n=1; LA-diameter 55.6±7.3 mm) or CABG surgery (n=3). Follow-up was performed at 3, 6, 9, 12, 18 and 24 months; 75% had stable sinus rhythm (SR) at late follow-up. Almost 90% of the patients with a preoperative LA-diameter of <56mm had SR. Conclusion: Isolation of the PVs using RF ablation procedures in combination with amiodarone therapy represents a safe and efficient option to cure pAF in patients undergoing open heart surgery.

Item Type:Journal (Paginated)
Keywords:Atrial fibrillation; atrial fibrillation surgery; radiofrequency ablation; arrhythmia surgery; heart valve surgery; maze surgery; bipolar radiofrequency ablation.
Subjects:JOURNALS > Indian Pacing and Electrophysiology Journal
ID Code:4257
Deposited By: Indian Pacing and Electrophysiology, Journal
Deposited On:20 Apr 2005
Last Modified:11 Mar 2011 08:55

References in Article

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1. Benjamin EJ, Wolf PA, D’ Agostino RB, Silbershatz H, Kannel WB, Levy D. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation 1998; 98:946-952.

2. Jessurun UR, van Hemel NM, Kelder JC, Elbers S, de la Riviere AB, Defauw JJ, Ernst JM. Mitral valve surgery and atrial fibrillation: Is atrial fibrillation surgery also needed? Eur J Cardiothorac Surg 2000;17:530-537.

3. Morris JJ Jr, Entman M, North WC, Kong Y, McIntosh H. The changes in cardiac output with reversion of atrial fibrillation to sinus rhythm. Circulation 1995;31:670-678.

4. ACC/AHA/ESC Guidelines for the management of patients with atrial fibrillation: Executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the management of patients with atrial fibrillation. Circulation 2001;104:2118-2150.

5. Cox JL, Schuessler RB, Lappas DG, Boineau JP. An 8 _ year clinical experience with surgery for atrial fibrillation. Ann Thorac Surg 1996; 224:267-275.

6. Chen MC, Gou GBF, Chang JP, Yeh KH, Fu M: Radiofrequency and cryoablation of atrial fibrillation in patients undergoing valvular operations. Ann Thorac Surg. 1998; 65:1666-1672.

7. Sueda T, Nagata H, Oriashi K, Morita S, Okada K, Sueshiro M, Hirai S, Matsuura Y. Efficacy of a simple left atrial procedure for chronic atrial fibrillation in mitral valve operations. Ann Thorac Surg 1997;63:1070-1075.

8. Pasic M, Bergs P, Müller P, Hofmann M, Grauhan O, Kuppe H, Hetzer R. Intraoperative radiofrequency maze ablation for atrial fibrillation: The Berlin modification. Ann Thorac Surg 2001;72:1484-91

9. Benussi S, Pappone C, Nascimbene S, Oreto G, Caldarola A, Stefano PL, Casati V, Alfieri O. A simple way to treat chronic atrial fibrilation during mitral valve surgery: the epicardial radiofrequency approach. Eur J Cardiothorac Surg 2000;17:524-529.

10. Melo J, Andragao P, Neves J, Ferreira M, Timoteo A, Santiago T, Ribeiras R, Canada M. Endocardial and epicardial radiofrequeny ablation in the treatment of atrial fibrillation with a new intraoperative device. Eur J Cardio-thorac Surg 2000;18:182- 186.

11. Khargi K, Kuschkowitz F, Deneke T, Lemke B, Haardt H, Müller KM, Laczkovics. Cooled-tip-radiofrequency ablation is a distinct different technique to treat chronic atrial fibrillation. A prospective study including 138 patients. Thorac Cardiovasc Surg 2003;51,Suppl 1:S52.

12. Hornero F, Montero JA, Canovas S, Bueno M. Biatrial radiofrequency ablation for atrial fibrillation: epicardial and endocardial surgical approach. Interactive Cardiovascular and Thoracic Surgery 2002;1:72-77.

13. Knaut M, Tugtekin SM, Gulielmos V. Microwave ablation as an additional procedure for treatment of permanent atrial fibrillation in patients with cardiosurgical disease. Thorac Cardiovasc Surg 2003;51,Suppl 1,S51.

14. Schütz A, Schulze C, Sarvanakis C, Platzer H, Kilger E, Lamm P, Wildhirt SM, Reichert B. Subendocardial microwave ablation in the treatment of chronic permanent atrial fibrillation. Thorac Cardiovasc Surg 2003;51,Suppl 1,S52.

15. Geidel S, Lass M, Boczor S, Kuck KH, Ostermeyer J: Surgical treatment of permanent atrial fibrillation during heart valve surgery. Interactive Cardiovascular and Thoracic Surgery 2003; 2: In print.

16. Mohr FW, Doll N, Falk V, Walther T, Hindricks G, Kottkamp H. Curative treatment of atrial fibrillation: acute and midterm results of intraoperative radiofrequency ablation of atrial fibrillation in 150 patients. Read at the Eighty-first Annual Meeting of The American Association of Thoracic Surgery, May 7, 2001.

17. Gillinov AM, Pettersson G, Rice TW. Esophageal injury during radiofrequency ablation for atrial fibrillation. J Thorac Cardiovasc Surg 2001;122:1239-40.

18. Li D, Fareh S, Leung TK, Nattel S. Promotion of atrial fibrillation by heart failure in Dogs. Atrial remodeling of a different sort. Circulation 1999;100:87-95.

19. Goette A. Staack T, Röcken C, Arndt M, Geller JC, Huth C, Ansorge S, Klein HU, Lendeckel U. Increased expression of extracellular signal-regulated kinase and angiotensin-converting enzyme in human atria during atrial fibrillation. JACC 2000; 35:1669-1677.

20. Kawara T, Derksen R, de Groot JR, Coronel R, Tasseron S, Linnenbank AC, Hauer RNW, Kirkels H, Janse MJ, de Bakker JMT. Activation delay after premature stimulation in chronically diseased human myocardium relates to the architecture of interstitial fibrosis. Circulation 2001;104:3069-3075.

21. Haissaguerre M, Jais P, Shah DC, Takahashi A, Hocini M, Quiniou G, Garrigue S, Le Mouroux A, Le Metayer P, Clementy J. Spontaneus initiation of atrial fibrillation by ectopic beats originating from the pulmonary veins. N Engl J med 1998;339: 659-666.

22. Roy D, Talajic M, Dorian P, Connolly S, Eisenberg MJ, Green M, Kus T, Lambert J, Dubuc M, Gagne P, Nattel S, Thibault B. Amiodarone to prevent recurrence of atrial fibrillation. N Engl J Med 2000;342:913-920.

23. Moe GK: On the multiple wavelet hypothesis of atrial fibrillation. Arch Int Pharmacodyn Ther 1962;140:183-188.

24. Allessie M, Lammers WJEP, Bunke FI, Hollen J. Experimental evaluation of Moe’s multiple wavelet hypothesis of atrial fibrillation. In: Zipes D, Jalife J, eds. Cardiac Electrophysiology and Arrhythmias. New York: Cruno and Straiton 1985;265-275.

25. Wijffels MCEF, Kirchhof CJHJ, Doland R et al. Atrial fibrillation begets atrial fibrillation. Circulation 1995 ;92 :1954-1968.

26. Jansz P, Bennetts J, Wilson M, Spratt P, Farnsworth A. Restoration of sinus rhythm following mitral valve surgery with left atrial reduction in patients with chronic atrial fibrillation. Abstract 38, Annual Scientific Meeting of the Society of Cardiothoracic Surgeons of Great Britain and Ireland, 2003.

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