Intraoperative radiofrequency maze ablation for atrial fibrillation: the Berlin modification.
BACKGROUND
The Cox-maze procedure combined with an operation for organic heart disease is highly successful in the elimination of chronic atrial fibrillation. However, it prolongs significantly the aortic cross-clamp and operating time. In this study, a simplified left atrial maze procedure, which is a short procedure performed using a surgical radiofrequency ablation probe, is added to elective open heart procedures in patients with atrial fibrillation.


METHODS
Forty-eight adults with atrial fibrillation (duration, 6 months to 36 years) underwent elective open heart operations (isolated valve procedures or coronary artery bypass grafting, n = 27 patients; combined procedures, n = 21 patients) combined with intraoperative radiofrequency ablation of the left atrium. The postoperative follow-up period ranged from 1 to 11 months (mean, 4 months). Possible predictors for persistent postoperative atrial fibrillation were determined among 40 variables by univariate and multivariate analyses.


RESULTS
Intraoperative radiofrequency ablation prolonged the aortic cross-clamp time for 6 to 14 minutes (mean, 11 minutes). Freedom from atrial fibrillation was 100% intraoperatively, 25% at 1 week after operation (12 of 48 patients), 59% at 1 month postoperatively (16 of 27 patients), 64% at 3 months postoperatively (16 of 25 patients), and 92% at 6 months postoperatively (12 of 13 patients). The only predictor of postoperative atrial fibrillation was the presence of coronary artery disease (odds ratio, 7.5; 80% confidence interval, 2.24-25.13).


CONCLUSIONS
Intraoperative radiofrequency ablation of the left atrium combined with an operation for organic heart disease effectively eliminates atrial fibrillation without significant prolongation of the aortic cross-clamp and operative time. The presence of coronary artery disease decreases the success rate during the first 6 postoperative months.
Pasic
M
M
Deutsches Herzzentrum Berlin, Germany. pasic@dhzb.de
Bergs
P
P
Müller
P
P
Hofmann
M
M
Grauhan
O
O
Kuppe
H
H
Hetzer
R
R
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D001604:Berlin; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods; D017115:Catheter Ablation / Q000009:adverse effects / Q000295:instrumentation; D004867:Equipment Design; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology