Intra-operative cooled-tip radiofrequency linear atrial ablation to treat permanent atrial fibrillation.
OBJECTIVE
To demonstrate the safety and efficacy of saline irrigated cooled-tip atrial linear endocardial radiofrequency ablation (SICTRA) concomitant to open-heart surgical procedures in the treatment of permanent atrial fibrillation (AF).


RESULTS
Two hundred and twenty-two patients presenting with permanent AF and the need for cardiac surgery were included. In addition to the cardio-surgical procedure [mitral valve (MV) surgery (n = 94), aortic valve replacement (n = 29), bypass surgery (n = 76 including 24 patients with additional MV surgery), and combined procedures (n = 23)] concomitant SICTRA was performed. In 116 patients, the ablation pattern was restricted to the left atrium alone. During the mean follow-up of 29 months, 174 patients (78%) converted to sinusrhythm (SR). In patients with SICTRA restricted to the left atrium conversion rates were not different compared to a biatrial approach (83 vs. 74%, P = 0.47). Thirty-days mortality was found to be 4% (9/222). Post-mortem evaluation revealed 23% of all lesions to be histologically non-transmural. In the overall group, only 4% of patients developed sustained secondary regular atrial arrhythmia.


CONCLUSIONS
SICTRA safely and effectively restores stable SR in 78% of patients with permanent AF undergoing open-heart surgery. Rhythm outcome is not influenced by treatment of the right atrium. Sustained regular atrial arrhythmia with the need for invasive treatment strategies occurs in 4% although intra-operative ablation lesions are often non-transmural.
Deneke
Thomas
T
University Heart Center Bochum, BG University-Hospital Bergmannsheil, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany. thomas.deneke@rub.de
Khargi
Krishna
K
Lemke
Bernd
B
Lawo
Thomas
T
Lindstaedt
Michael
M
Germing
Alfried
A
Brodherr
Turgut
T
Bösche
Leif
L
Mügge
Andreas
A
Laczkovics
Axel
A
Grewe
Peter H
PH
Fritz
Markus
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000637:transplantation; D001281:Atrial Fibrillation / Q000401:mortality / Q000601:surgery*; D017115:Catheter Ablation / Q000295:instrumentation* / Q000379:methods; D003131:Combined Modality Therapy / Q000379:methods; D001026:Coronary Artery Bypass / Q000379:methods; D005500:Follow-Up Studies; D006801:Humans; D007432:Intraoperative Period; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery