A prospective multicenter trial of bipolar radiofrequency ablation for atrial fibrillation: early results.
BACKGROUND
The Cox-Maze III remains the gold standard for the surgical treatment of atrial fibrillation. However, the "cut-and-sew" technique is time consuming and technically challenging. The pulmonary veins are the source of ectopy in the majority of patients with atrial fibrillation. The safety and efficacy of bipolar radiofrequency to electrically isolate the pulmonary veins was evaluated in a prospective multi-center trial.


METHODS
Beginning in January 2002, 30 patients at three medical centers underwent pulmonary vein isolation using bipolar radiofrequency and were followed for 6 months. Twenty-four of the patients also underwent a modified Cox-Maze III. Electrical isolation of the pulmonary veins was confirmed with intraoperative pacing. Pulmonary vein patency was assessed by magnetic resonance imaging or three-dimensional computed tomography in 15 patients at 1 month.


RESULTS
Mean age was 60.9 +/- 11.7 years. Nineteen patients had paroxysmal atrial fibrillation. All pulmonary veins were isolated in every patient. The left pulmonary veins underwent 3.0 +/- 1.4 applications for a total of 26.4 +/- 10.5 seconds. The right pulmonary veins underwent 2.8 +/- 1.1 applications for a total of 26.3 +/- 12.6 seconds. There was no operative mortality. At 1 month, imaging revealed no evidence of pulmonary vein stenosis. At 6 months, 96% of patients were in normal sinus rhythm.


CONCLUSIONS
The use of bipolar radiofrequency for electrical isolation of pulmonary veins and to replace other Cox-Maze III incisions is safe and effective at controlling atrial fibrillation. This emerging technology may shorten and simplify the surgical management of atrial fibrillation.
Mokadam
Nahush A
NA
Division of Cardiothoracic Surgery, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
McCarthy
Patrick M
PM
Gillinov
A Marc
AM
Ryan
William H
WH
Moon
Marc R
MR
Mack
Michael J
MJ
Gaynor
Sydney L
SL
Prasad
Sunil M
SM
Wickline
Samuel A
SA
Bailey
Marci S
MS
Damiano
Nicholas R
NR
Ishii
Yosuke
Y
Schuessler
Richard B
RB
Damiano
Ralph J
RJ
D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000188:drug therapy / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy; D002304:Cardiac Pacing, Artificial; D002315:Cardiopulmonary Bypass; D017115:Catheter Ablation / Q000295:instrumentation / Q000379:methods*; D003131:Combined Modality Therapy; D004554:Electric Countershock; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000601:surgery; D006801:Humans; D021621:Imaging, Three-Dimensional; D007430:Intraoperative Care; D007902:Length of Stay / Q000706:statistics & numerical data; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000294:innervation / Q000601:surgery*; D012074:Remission Induction; D016896:Treatment Outcome
D000889:Anti-Arrhythmia Agents