Radiofrequency Bipolar Surgical Ablation for Atrial Fibrillation

Abstract

I read The Society of Thoracic Surgeons 2017 Clinical Practice Guidelines for the surgical treatment of atrial fibrillation (AF) [1Badhwar V. Rankin J.S. Damiano Jr., R.J. et al.The Society of Thoracic Surgeons 2017 clinical practice guidelines for the surgical treatment of atrial fibrillation.Ann Thorac Surg. 2017; 103: 329-341Abstract Full Text Full Text PDF PubMed Scopus (290) Google Scholar]. In the introduction, the first experimental accomplishment of the creation of myocardial ablation lines, as a treatment for atrial arrhythmias by Williams and associates finds mention. Our publication [2Patwardhan A.M. Dave H.H. Tamhane A.A. et al.Intraoperative radiofrequency microbipolar coagulation to replace incisions of Maze III procedure for correcting atrial fibrillation in patients with rheumatic valvular disease.Eur J Cardiothorac Surg. 1997; 12: 627-633Crossref PubMed Scopus (89) Google Scholar] in 1997 has been referenced in the guidelines, stating “Modifications of the atrial lesion sets ensued as new energy sources were developed.” Also mentioned is the contribution of Damiano and associates [3Gaynor S.L. Diodato M.D. Prasad S.M. et al.A prospective, single center clinical trial of a modified Cox maze procedure with bipolar radiofrequency ablation.J Thorac Cardiovasc Surg. 2004; 128: 535-542Abstract Full Text Full Text PDF PubMed Scopus (237) Google Scholar], who used a combination of radiofrequency (RF) energy and cryoablation to replace several of the maze III cut-and-sew lesions; they called this facilitated procedure the “Cox-Maze IV.” In this context, I would like to share a few facts that are not so well known. To our knowledge, we were the first to apply clinically RF in the bipolar mode for surgical ablation of AF and the first to use this ablative modality to replace incisions of the Cox-Maze III procedure [2Patwardhan A.M. Dave H.H. Tamhane A.A. et al.Intraoperative radiofrequency microbipolar coagulation to replace incisions of Maze III procedure for correcting atrial fibrillation in patients with rheumatic valvular disease.Eur J Cardiothorac Surg. 1997; 12: 627-633Crossref PubMed Scopus (89) Google Scholar]. At the end of this publication, we stated that if this modification proved durable in the long term, it could possibly bring a change in clinical practice in this field globally. We believe that this has taken place. I thought this may be of interest to readers who are looking for history of surgical ablation of AF. The Society of Thoracic Surgeons 2017 Clinical Practice Guidelines for the Surgical Treatment of Atrial FibrillationThe Annals of Thoracic SurgeryVol. 103Issue 1PreviewSurgical ablation for atrial fibrillation (AF) can be performed without additional risk of operative mortality or major morbidity, and is recommended at the time of concomitant mitral operations to restore sinus rhythm. (Class I, Level A) Surgical ablation for AF can be performed without additional operative risk of mortality or major morbidity, and is recommended at the time of concomitant isolated aortic valve replacement, isolated coronary artery bypass graft surgery, and aortic valve replacement plus coronary artery bypass graft operations to restore sinus rhythm. Full-Text PDF