Surgical ablation of permanent atrial fibrillation by means of maze radiofrequency: mid-term results.
BACKGROUND
The maze procedure can be performed surgically with radiofrequency, generating transmural ablation lines. We report our experience with a biatrial pattern of lesions based on the use of epicardial and endocardial radiofrequency ablation in an effort to minimize maze procedure.


METHODS
In 85 patients undergoing cardiac surgery for established permanent atrial fibrillation (>3 months), a biauricular pattern of epicardic-endocardic maze lesions was performed. The main surgical procedures were diverse: 42 mitral valve surgeries, 7 mitrotricuspid valves, 18 mitroaortics, 4 mitroaortic and tricuspids, 2 aortic valves, 3 CABGs, 5 CABG and valve procedures, and 4 atrial septal defects. The mean age of the patients was 61 +/- 12 (range 39-78). The mean duration of atrial fibrillation was 5.8 years (range 0.3 to 24).


RESULTS
Sixty-two (72.9%) patients presented postoperative supraventricular arrhythmia. Hospital mortality was seen in five patients (5.8%). Two patients died after a 12-month mean follow-up (range 2 to 32). A total of 14.1% of patients remained with their previous atrial fibrillation and 85.9% recovered and maintained sinus rhythm, with two patients having a permanent pacemaker. A total of 56% patients have been followed-up for a period of more than 6 months, and among them prevalence of sinus rhythm is 87.5%. Echocardiography detected biauricular contraction in 65% of them. After analyzing the data, factors involved in postoperative recurrence of atrial fibrillation after radiofrequency surgery were oldness of the atrial fibrillation (p < 0.01) and pre and postoperative left auricle volume (p < 0.04).


CONCLUSIONS
Intraoperative radiofrequency has permitted us to perform the maze procedure in a simple way, with a low surgical morbid-mortality. We have obtained an 85.9% electrographic effectiveness and a 65% recovery of atrial contraction. Postoperative incidence of arrhythmia is the main postoperative problem.
Hornero
Fernando
F
Department of Cardiac Surgery, University General Hospital of Valencia, Spain. hornero_fer@gva.es
Rodríguez
Ignacio
I
Bueno
Maria
M
Buendía
Jose
J
Dalmau
Maria J
MJ
Canovas
Sergio
S
Gil
Oscar
O
Garcia
Rafael
R
Montero
Jose A
JA
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006331:Heart Diseases / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome