Outcomes for the Surgical Treatment of Atrial Fibrillation Using Cryoablation During Concomitant Cardiac Procedures

Abstract

Background. Surgical treatment of atrial fibrillation (AF) with heat-based therapies has been associated with a high rate of arrhythmia recurrence. We studied the short-term to medium-term outcomes with a unique biatrial linear ablation procedure for AF treatment using an argon-based cryoablation device during concomitant cardiac operations. Methods. Between March 2005 and July 2008, 57 patients (47% men) with problematic AF underwent a linear endocardial ablation procedure (Star pattern) using the flexible argon-based cryoablation probe during concomitant cardiac operations. Procedures were performed with valve or coronary operations, including mitral valve replacement (25%), mitral valve repair (16%), coronary artery bypass grafts (21%), and congenital heart surgery (8%). Atrial fibrillation was persistent or long-standing persistent in 50.9% of patients. Results. Kaplan-Meier survival curves (with the standard error) demonstrated 91% (3.9%) of patients were still free of their first recurrence at 6 months, 81% (5.6%) at 12 months, and 70% (6.8%) at 24 months. Time to first recurrence was not significantly associated with age (p 0.47), gender (p 0.52), or type of AF (p 0.69). There were no complications attributed to the cryoablation procedure. There was one in-hospital death and one death after discharge. Twelve patients (21%) required permanent pacemaker implantation postoperatively. There were no early or late thromboembolic events. Conclusions. This study demonstrated the mediumterm efficacy of cryoablation with a unique biatrial pattern of linear lesions for the treatment of AF during a concomitant cardiac operation. Short-term to mediumterm outcomes were at least equivalent to those reported for other energy modalities.