Efficacy of an additional MAZE procedure using cooled-tip radiofrequency ablation in patients with chronic atrial fibrillation and mitral valve disease

Institute of Pathology, Ruhr-Universität Bochum, Bochum, North Rhine-Westphalia, Germany
European Heart Journal (Impact Factor: 15.2). 04/2002; 23(7):558-66. DOI: 10.1053/euhj.2001.2841
Source: PubMed

ABSTRACT This study is the first prospective randomized trial evaluating the efficacy of an antiarrhythmic surgical procedure in patients with chronic atrial fibrillation undergoing mitral valve replacement.
Thirty consecutive patients with chronic atrial fibrillation undergoing mitral valve replacement were randomized for an additional modified MAZE-operation using intra-operatively cooled-tip radiofrequency ablation (group A) or mitral valve replacement alone (group B). Biatrial contraction was studied and functional capacity was evaluated in spiro-ergometry 6 months after surgery. Thirty-day mortality was 0% in both groups. After 12 months, sinus rhythm was reinstituted significantly more often in patients of group A (cumulative rate of sinus rhythm 0.800) compared to patients in group B (0.267) (P<0.01). 66.7% of patients in sinus rhythm of group A had documented biatrial contraction. Electrocardioversion showed long-term success in only 17% of patients in group A and 0% in group B. Maximal aerobic uptake at the 6-month spiro-ergometry revealed no significant difference (9.3 vs 8.5 ml x min(-1) kg(-1), P=0.530).
A modified MAZE operation using cooled-tip radiofrequency ablation can be safely combined with mitral valve surgery and is highly effective in restoring sinus rhythm. Biatrial contraction is found in 66.7% of patients with sinus rhythm undergoing mitral valve replacement plus the MAZE operation.

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Available from: Thomas Deneke, Sep 28, 2015
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    • "What RFA lesions have in common in all studies is complete isolation of all the pulmonary lesions associated with at least one line drawn towards the mitral valve annulus. Deneke et al. [18] compared the outcomes of 15 patients who had a combined procedure with 15 patients who had valve surgery alone. At 12 months, 81.8% of patients with left-sided ablation were in sinus rhythm versus 21.4% in the surgery-alone group. "
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    ABSTRACT: Randomized studies evaluating left atrial radiofrequency ablation (RFA) in patients with persistent atrial fibrillation undergoing mitral valve surgery are scarce and monocentric. To evaluate the efficacy of left atrial RFA concomitant with mitral valve surgery to restore and maintain sinus rhythm. The SAFIR is a multicentre, double-blinded, centrally randomized study involving four university hospitals. Between December 2002 and September 2005, 43 patients with mitral valve disease and long-standing, persistent atrial fibrillation (duration>6 months) were included. We compared valvular surgery alone (n=22) or with left atrial RFA (n=21). The main endpoint was sinus rhythm at 12 months without recurrence of arrhythmia during follow-up. Secondary endpoints were surgical adverse events, atrial fibrillation relapses, stroke and echocardiographic measurements after three and 12 months' follow-up. Analyses of the efficacy criteria were performed on an intention-to-treat basis. The primary endpoint occurred significantly more often in the RFA group than in the control group (respectively, 12/21 patients [57%] vs 1/22 patients [4%]; p=0.004). There were more patients with sinus rhythm in the RFA group than in the control group at discharge (72.7% vs 4.8%; p<0.005), 3-month follow-up (85.7% vs 23.8%; p<0.01) and 12-month follow-up (95.2% vs 33.3%; p<0.005). The patients in the RFA group had similar rates of postoperative complications and stroke during follow-up as those in the control group. This multicentre study suggests that left atrial RFA is effective and safe in patients with chronic atrial fibrillation and mitral valve disease.
    Archives of cardiovascular diseases 11/2009; 102(11):769-75. DOI:10.1016/j.acvd.2009.08.010 · 1.84 Impact Factor
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    • "Benussi et al. have shown that all patients who recover sinus rhythm after epicardial catheter ablation and mitral surgery also recover biatrial contractility 3 months after the operation [15]. When surgical ablation was performed by the endocardial route and with unipolar radiofrequency, only 67% of patients in sinus rhythm recovered biatrial electrical conduction [16]. This difference would appear to be linked to the more limited trauma of the atrial myocardium after epicardial ablation by bipolar radiofrequency [15]. "
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    ABSTRACT: Atrial fibrillation is the most frequent form of cardiac arrhythmia. Its surgical management has improved in recent years with major advances in our knowledge of the underlying pathogenic mechanisms. This has led to simpler therapeutic strategies such as epicardial ablation. The aim of this comparative experimental study was to evaluate the efficacy of this treatment, achieved with either bipolar radiofrequency or cryoablation. Twelve sheep were used. After left thoracotomy, epicardial ablation of the junction between the left pulmonary veins and the left atrium was achieved by means of bipolar radiofrequency in group A (n=6) and by cryoablation in group B (n=6). Electrical stimulation thresholds were determined before and after ablation. Four weeks after ablation, sheep were killed for pathologic studies. The mean stimulation threshold was 3.5+/-0.6 mA before ablation and 15.6+/-5.6 mA after ablation. The difference was significant in both groups, showing that effective conduction blockade was obtained with the two ablation methods. Histologic studies after radiofrequency and cryoablation showed limited coagulation necrosis and cellular rarefaction, respecting the supportive tissue. Both methods of surgical ablation by the epicardial route yielded effective electrical isolation of the pulmonary vein junction with the left atrium. This conduction blockade was due to limited coagulation necrosis with myocyte rarefaction, of similar extents in the two procedures. Standardization and refinement of this technique could extend the treatment indications for atrial fibrillation associated with other cardiac disorders that require surgical treatment without opening the left atrium.
    Archives of Cardiovascular Diseases 11/2008; 101(11-12):763-8. DOI:10.1016/j.acvd.2008.07.004 · 1.84 Impact Factor
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    • "The surgical option of the MAZE procedure has demonstrated a high level of success but is only indicated in patients requiring a mitral valve replacement (Scheinman & Morady 2001, Deneke et al. 2002). The success rate of MAZE is high up to 90% two to three years postoperatively and has a low mortality rate of 1% (Scheinman & Morady 2001, Deneke et al. 2002). For patients who develop AF immediately after cardiac surgery, the use of magnesium and potassium is recommended although ideally patients should be treated prophylactically preoperatively to avoid the risk of AF in the postoperative recovery period (Chung 2000, Booth et al. 2003). "
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    ABSTRACT: The aim of this paper is to review the current literature describing the aetiology of atrial fibrillation and to examine the evidence for rate reversion and rate control. Atrial fibrillation is the most commonly seen arrhythmia within the clinical setting. Treatment depends on severity of symptoms, which are predominantly palpitations and shortness of breath. The primary complications from atrial fibrillation are thrombo-embolic events (such as a pulmonary embolus or stroke). A comprehensive literature review on atrial fibrillation, rate reversion and rate control was undertaken to examine the incidence of atrial fibrillation, to review research on management of atrial fibrillation and to determine if rate reversion was superior to rate control in the treatment of atrial fibrillation. Many studies have been carried out to determine the best treatment for this condition. The choices are currently pharmacological and electrical cardioversion in conjunction with anticoagulant therapy. Drug therapies are not without their problems, especially toxicity and the need for close clinical monitoring. Transaesophageal echocardiography has been used to establish the presence of left atrial thrombi and aims to reduce the anticoagulation time and reduce the risk of thrombo-embolic events. A randomized comparative study of transaesophageal echocardiography and conventional anticoagulation therapy prior to cardioversion demonstrated statistically significant reduction in haemorrhagic events and a shorter time to cardioversion in those in the transaesophageal echocardiography group compared with the conventional group. For those with persistent atrial fibrillation, surgery is an option with valve repair or replacement carried out in conjunction with a bi-atrial surgical ablation. The management of atrial fibrillation is dependent on many factors and to date there are no proven clinical rationale for rate control or reversion. Atrial fibrillation requires immediate attention in order to avoid thrombo-embolic complications and the use of transaesophageal echocardiography and conventional anticoagulation therapy can significantly reduce these complications.
    Journal of Clinical Nursing 02/2007; 16(1):77-83. DOI:10.1111/j.1365-2702.2006.01559.x · 1.26 Impact Factor
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