Abstract
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). 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. 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.
Highlights
Atrial fibrillation (AF)—due to increasing patient numbers and its prognostic relevance—is recognized as a major health-care problem
Incisional tachycardia was documented to be the electrophysiological mechanism in three patients. This is the first report on anti-atrial fibrillation (AF) surgery performed using endocardial cooled-tip radiofrequency ablation (SICTRA) in a large patient collective heterogeneous in regard to the underlying cardiac pathology but homogenous in regard to the treated cardiac arrhythmia and postoperative antiarrhythmic treatment regimen
In 78% of all patients, stable SR was re-established after long-lasting permanent AF producing a biatrial contraction pattern in 82% of patients studied in SR
Summary
Atrial fibrillation (AF)—due to increasing patient numbers and its prognostic relevance—is recognized as a major health-care problem. Up to 58% of patients (3.5% of all patients) prior to cardiac surgery have documented AF.[1,2,3,4]. Integrating these facts into clinical practise, AF surgery has become more engaged in every-day practise of cardiosurgical centres. The cut-and-sew technique to perform the maze procedure still remains the gold standard for antiarrhythmic surgery documenting superior efficacy. In order to facilitate and shorten anti-AF procedures, different techniques [radiofrequency- (RF), microwave-, cryo-ablation] to induce linear atrial conduction blocking lesions have been studied. RF ablation is extensively used in invasive electrophysiology and has been established as standard energy source to perform endocardial ablation.[3,4,5,6,7,8,9,10]
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