title: Surgical ablation of atrial fibrillation using the epicardial radiofrequency approach: mid-term results and risk analysis.
abstract: BACKGROUND
  The minor technical and time requirements with respect to the maze operation combined with a comparable efficacy has led to an increasing popularity of left atrial approaches to treat atrial fibrillation. We report our experience with a left atrial procedure based on extensive use of epicardial radiofrequency ablation in an effort to minimize cardiac arrest time.
  
  
  METHODS
  A total of 132 consecutive patients with atrial fibrillation (121 chronic, 11 paroxysmal) undergoing open heart surgery had combined intraoperative ablation. An original set of left atrial lesions was performed using a radiofrequency linear catheter. Most of the ablations were performed epicardially before aortic cross-damping. Patients with contraindications to the epicardial approach had the whole lesion set performed endocardially.
  
  
  RESULTS
  The mean cardiac arrest time spent for open heart ablations was significantly shorter (5.2 +/- 0.9 minutes with modem catheters) when the epicardial approach was used (107 of 132 patients, 81%). Hospital mortality was 0.8%. Freedom from atrial fibrillation was 77% 3 years after the operation. Of all the variables analyzed, only age at surgery and early postoperative arrhythmias increased the risk of recurrent atrial fibrillation. Overall 3-year survival was 94%. The 3-year actuarial freedom from stroke was 98%. No patient required implantation of a permanent pacemaker. Atrial contractility was recovered in all patients with stable sinus rhythm.
  
  
  CONCLUSIONS
  Left atrial radiofrequency ablation allows recovery of sinus rhythm and atrial function in the great majority of patients with atrial fibrillation who undergo open heart surgery. The epicardial radiofrequency approach is a safe and effective means to cure atrial fibrillation with negligible technical and time requirements.
authors.affiliation: Division of Cardiac Surgery, S Raffaele University Hospital, Milan, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Benussi
authors.forename: Simona
authors.initials: S
authors.lastname: Nascimbene
authors.forename: Eustachio
authors.initials: E
authors.lastname: Agricola
authors.forename: Giliola
authors.initials: G
authors.lastname: Calori
authors.forename: Simone
authors.initials: S
authors.lastname: Calvi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Caldarola
authors.forename: Michele
authors.initials: M
authors.lastname: Oppizzi
authors.forename: Valter
authors.initials: V
authors.lastname: Casati
authors.forename: Carlo
authors.initials: C
authors.lastname: Pappone
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
mesh_terms: D001281:Atrial Fibrillation / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000601:surgery; D016896:Treatment Outcome