European Heart Journal Advance Access published online on October 23, 2007
European Heart Journal, doi:10.1093/eurheartj/ehm397
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Intra-operative cooled-tip radiofrequency linear atrial ablation to treat permanent atrial fibrillation
University Heart Center Bochum, BG University-Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany
Received 26 January 2007; revised 9 August 2007; accepted 24 August 2007.
* Corresponding author. Tel: +49 234 302 3476; fax: +49 234 302 6084. E-mail address: thomas.deneke{at}rub.de
Aims: To demonstrate the safety and efficacy of saline irrigated cooled-tip atrial linear endocardial radiofrequency ablation (SICTRA) concomitant to open-heart surgical procedures in the treatment of permanent atrial fibrillation (AF).
Methods and Results: Two hundred and twenty-two patients presenting with permanent AF and the need for cardiac surgery were included. In addition to the cardio-surgical procedure [mitral valve (MV) surgery (n = 94), aortic valve replacement (n = 29), bypass surgery (n = 76 including 24 patients with additional MV surgery), and combined procedures (n = 23)] concomitant SICTRA was performed. In 116 patients, the ablation pattern was restricted to the left atrium alone.
During the mean follow-up of 29 months, 174 patients (78%) converted to sinusrhythm (SR). In patients with SICTRA restricted to the left atrium conversion rates were not different compared to a biatrial approach (83 vs. 74%, P = 0.47). Thirty-days mortality was found to be 4% (9/222). Post-mortem evaluation revealed 23% of all lesions to be histologically non-transmural. In the overall group, only 4% of patients developed sustained secondary regular atrial arrhythmia.
Conclusions: SICTRA safely and effectively restores stable SR in 78% of patients with permanent AF undergoing open-heart surgery. Rhythm outcome is not influenced by treatment of the right atrium. Sustained regular atrial arrhythmia with the need for invasive treatment strategies occurs in 4% although intra-operative ablation lesions are often non-transmural.
Key Words: Antiarrhythmic surgery • Intra-operative endocardial ablation of atrial fibrillation • Permanent atrial fibrillation • Anti-atrial fibrillation surgery
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