title: New ablation techniques for atrial fibrillation and the minimally invasive cryo-maze procedure in patients with lone atrial fibrillation.
abstract: Atrial fibrillation (AF) is associated with significant morbidity and mortality. Medical management is often palliative but new ablation techniques have enabled curative approaches. Catheter-based ablation has limited success, whilst surgical approaches are widely applicable with favourable results. The minimally invasive Cryo-Maze (MICM) replicates the lesions of the Cox-Maze procedure using cryotherapy. We present our retrospective review of all Cryo-Maze procedures performed at East Carolina University, from October 2003 to January 2006, with analysis of all MICM's for lone AF, via a small right inframammary incision. A total of 41 patients (29 male, 12 female, age 61.6+/-9.7 years) with lone AF underwent an MICM as a primary operation. There were no deaths or early or late strokes. At discharge 36 patients (87.8%) were in sinus. At six weeks, this ratio had increased to 90.2% (37/41). The rate of SR continued to improve and for those out three months, the rate increased to 92.7% (38/41). At six months, 87.2% (34/39) were in SR. SR was seen in 20/23 patients with follow-up beyond one year (87.0%). In conclusion, surgical ablation techniques that replicate the Cox-Maze procedure are associated with high rates of sinus rhythm beyond one year, with wide application. AF is a curable condition, using a combination of catheter-based and surgical approaches. Newer surgical ablation devices allow minimally invasive approaches.
authors.affiliation: Victorian Heart Center, Epworth Hospital and Austin Health, Victoria, Australia. scmoten@bigpond.com
authors.forename: Simon C M
authors.initials: SC
authors.lastname: Moten
authors.forename: Evelio
authors.initials: E
authors.lastname: Rodriguez
authors.forename: Richard C
authors.initials: RC
authors.lastname: Cook
authors.forename: L Wiley
authors.initials: LW
authors.lastname: Nifong
authors.forename: W Randolph
authors.initials: WR
authors.lastname: Chitwood
mesh_terms: D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D017115:Catheter Ablation / Q000295:instrumentation* / Q000379:methods; D017679:Cryotherapy / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009657:North Carolina; D011667:Pulmonary Veins; D012189:Retrospective Studies