title: Combined atrial septal defect surgical closure and irrigated radiofrequency ablation in adult patients.
abstract: BACKGROUND
  Atrial arrhythmias are relatively common among patients over 40 years old with atrial septal defect (ASD) and are a precipitating cause of heart failure. Surgical closure of the ASD in these patients is feasible and is associated with a low mortality rate and a beneficial effect on the clinical status; however the occurrence of atrial arrhythmia does not decrease after surgery. We present the results of our preliminary experience with surgical ASD closure combined with intraoperative irrigated radiofrequency (IRF) ablation in adult patients.
  
  
  METHODS
  During a 26-month period between September 2002 and December 2004, 15 patients more than 40 years old with ASD and atrial arrhythmia underwent elective surgical closure of the defect and intraoperative IRF ablation. All patients had supraventricular arrhythmias: 8 had permanent atrial fibrillation, whereas 7 had previous episodes of atrial flutter or intra-atrial reentry tachycardia. The biatrial approach (Cox-Maze III procedure) was used in 7 patients and a right-sided Maze procedure (ablation lines on the right atrium only) was carried out in the remaining 8 patients.
  
  
  RESULTS
  All patients survived the procedure. Fourteen patients left the operating room in sinus rhythm and 1 had a pacemaker implanted. There were no complications resulting from the IRF ablation. All 15 patients survived over the average follow-up period of 24 months. Thirteen patients were still in sinus rhythm, 1 had pacemaker rhythm, and only 1 (1 of 15; 6.5%) suffered a recurrence of atrial fibrillation 3 months after the procedure.
  
  
  CONCLUSIONS
  We suggest adding intraoperative IRF ablation during surgical closure of an ASD in all adult ASD patients with arrhythmias. The IRF ablation is easy to perform, safe, and effective.
authors.affiliation: Pediatric Cardiology and Cardiac Surgery Department, GUCH Unit, E. Malan Center, Policlinico San Donato, San Donato Milanese, Italy. alegia@hotmail.com
authors.forename: Alessandro
authors.initials: A
authors.lastname: Giamberti
authors.forename: Massimo
authors.initials: M
authors.lastname: Chessa
authors.forename: Sara
authors.initials: S
authors.lastname: Foresti
authors.forename: Raul
authors.initials: R
authors.lastname: Abella
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Butera
authors.forename: Carlo
authors.initials: C
authors.lastname: de Vincentiis
authors.forename: Mario
authors.initials: M
authors.lastname: Carminati
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Menicanti
authors.forename: Alessandro
authors.initials: A
authors.lastname: Frigiola
mesh_terms: D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000150:complications / Q000628:therapy*; D017115:Catheter Ablation; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000637:transplantation; D007507:Therapeutic Irrigation