We evaluated the effectiveness of the saline-irrigated-cooled-tip-radiofrequency ablation (SICTRA) to produce linear intraatrial lesions.
Thirty patients with chronic atrial fibrillation and mitral valve disease were consecutively randomized to have mitral valve operation either with a Maze procedure (group A) or without (group B). Intraatrial linear lesions were made with an SICTRA catheter (20 to 32 W; 200 to 320 mL/h saline). An echocardiography and 24-hour electrocardiogram were obtained 12 months postoperatively.
The cumulative frequencies of sinus rhythm in group A and B were 0.80 and 0.27 (p < 0.01). Restored biatrial contraction was present in 66.7% (6 of 9) of the group A patients in sinus rhythm. One patient from each group received a permanent pacemaker because of bradycardia. A fatal renal bleeding and mediastinitis occurred in 2 group A patients, 6 weeks postoperatively. One group A patient had sudden cardiac death at home, 4 months after operation. One patient from each group had lethal respiratory failure, 7 and 10 months after operation. Survival after 12 months for group A and B was 73% and 93% (p = 0.131).
The SICTRA appeared to be an effective technique to perform the Maze procedure.
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"Because its incidence increases with age, a growing number of patients scheduled for valvular or coronary heart surgery, nowadays present AF [6,7]. During the last decade, surgical AF treatment, initially introduced as Maze procedure [8,9], has been developed to a less complex operation by using different technologies for tissue ablation and by focussing the lesion pattern on the left atrium [7,10,11]. AF ablation has become a frequently performed concomitant procedure in cardiac surgery with overall promising results regarding sinus rhythm (SR) restoration [7,10]. "
[Show abstract][Hide abstract] ABSTRACT: Cardiac surgery is increasingly required in octogenarians. These patients frequently present atrial fibrillation (AF), a significant factor for stroke and premature death. During the last decade, AF ablation has become an effective procedure in cardiac surgery. Because the results of concomitant AF ablation in octogenarians undergoing cardiac surgery are still not clear, we evaluated the outcome in these patients.
Among 200 patients undergoing concomitant AF ablation (87% persistent AF), 28 patients were >/= 80 years (82 +/- 2.4 years). The outcome was analysed by prospective follow up after 3, 6, 12 months and annually thereafter. Freedom from AF was calculated according to the Kaplan-Meier method.
Octogenarians were similar to controls regarding AF duration (48 +/- 63.2 versus 63 +/- 86.3 months, n.s.) and left atrial diameter (49 +/- 6.1 versus 49 +/- 8.8 mm, n.s.), but differed in EuroSCORE (17.3 +/- 10.93 versus 7.4 +/- 7.31%, p < 0.001), prevalence of paroxysmal AF (25.0 versus 11.0%, p = 0.042) and aortic valve disease (67.8 versus 28.5%, p < 0.001). ICU stay (8 +/- 16.9 versus 4 +/- 7.2 days, p = 0.027), hospital stay (20 +/- 23.9 versus 14 +/- 30.8 days, p < 0.05), and 30-d-mortality (14.3 versus 4.6%, p = 0.046) were increased. After 12 +/- 6.1 months of follow-up (95% complete), 14 octogenarians (82%) and 101 controls (68%, n.s.) were in sinus rhythm; 59% without antiarrhythmic drugs in either group (n.s.). Sinus rhythm restoration was associated with improved NYHA functional class and renormalization of left atrial size. Cumulative freedom from AF demonstrated no difference between groups. Late mortality was higher in octogenarians (16.7 versus 6.1%, p = 0.065).
Sinus rhythm restoration rate and functional improvement are satisfactory in octogenarians undergoing concomitant AF ablation. Hence, despite an increased perioperative risk, this procedure should be considered even in advanced age.
Full-text · Article · Feb 2008 · Journal of Cardiothoracic Surgery
[Show abstract][Hide abstract] ABSTRACT: Objective: the aim of our study was to evaluate the safety and efficacy of radiofrequency (RF) ablation as a surgical adjunct in the treatment of atrial fibrillation (AF) and to adapt the Maze principles to mitral valve (MV) surgery using the transseptal approach (TA) and the septal-superior approach (SSA). Design and Methods: from January 2001 to January 2004, 37 patients with permanent or persistent AF underwent an irrigated RF modified Maze procedure in combination with MV surgery. Patients were prospectively assigned to a TA group (26 patients) or a SSA group (11 patients). Results: All the patients underwent a bi-atrial RF modified Maze procedure. The total mean time of the RF Maze procedure was 21 ± 3 min (range 15–30 min). In-hospital mortality was 2.7% (1 patient). 35 patients were free of AF at discharge. All the patients reached the 12-month follow-up, no AF or flutter was observed in 29 patients (81%) and 18 of them received no antiarrhythmics. Permanent pacing was necessary in 19% of the SSA group patients and in 18% of the TA group patients. Doppler echocardiographic examination detected the transmitral A wave in 85% of patients at 6 months postoperatively. Conclusions: irrigated radiofrequency modified Maze procedure using both transseptal and septal-superior approaches is an effective and safe procedure abolishing atrial fibrillation in 81% of patients at 12 months of follow-up.
"Our sinus rhythm conversion rate is similar to that of Mohr, who reported an SR at 1 year of 72.5% (58/80) and Sie, who observed an SR conversion rate of 72% (77/122) at 6 months follow up  . These results corroborate our previous observation  "
[Show abstract][Hide abstract] ABSTRACT: A surgical technique using unipolar radiofrequency ablation is described, which minimizes the risk of damaging adjacent cardiac structures. The left atrium was fully mobilized. Linear, non-thrombogenic, white blistering lesions were created with a hand-held malleable pen-catheter, making oscillating movements, while preserving a stable endocardium contact, without pressing the atrial wall to adjacent mediastinal structures. The ablated atrial tissue was lifted up with forceps. Each pulmonary vein orifice was circumferentially ablated and interconnected on the ipsi- and to the contra-lateral side, and to the left auricle and mitral valve annulus. No esophageal or circumflex artery injuries were observed.
Preview · Article · Jul 2004 · Interactive Cardiovascular and Thoracic Surgery