[Intraoperative high frequency current ablation as therapy of 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, a short procedure performed using a surgical radiofrequency ablation probe, is added to elective open-heart procedures in patients with atrial fibrillation.


METHODS
95 adults with atrial fibrillation (duration, 6 months to 33 years) underwent elective open heart operations (isolated valve procedures or coronary artery bypass grafting, n = 51 patients; combined procedures, n = 44 patients) combined with intraoperative radiofrequency ablation of the left atrium. The postoperative follow-up period ranged from 1 to 24 months (mean, 8 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 6-14 minutes (mean, 11 minutes). Freedom from atrial fibrillation was 100% intraoperatively, 30% at 1 week after operation, and 84% and 84% at 6 and 12 months postoperatively. 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.
Müller
Peter
P
Deutsches Herzzentrum Berlin.
Pasic
Miralem
M
Bergs
Peter
P
Hofmann
Michael
M
Kuppe
Hermann
H
Hetzer
Roland
R
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass / Q000379:methods*; D004564:Electrocoagulation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012008:Recurrence