title: Cryoablation for surgical treatment of chronic atrial fibrillation combined with mitral valve surgery: a clinical observation.
abstract: OBJECTIVE
  Although the classical Cox-Maze III is the gold standard surgical therapy with a proven efficacy in the treatment of atrial fibrillation (AF), complexity of this procedure has resulted in a search for a simpler, less invasive and more cost-effective method. In this study we evaluated the results of cryosurgical ablation in the treatment of chronic AF in patients undergoing concomitant mitral valve surgery.
  
  
  METHODS
  Ninety patients (mean age: 50.9+/-12 years) with chronic AF who were having mitral valve surgery as the main procedure underwent cryoablation with a newly designed N(2)O-based cryotherapy device. Pulmonary vein isolation with or without left atrial appendage closure (group A) was carried out in 65 cases and cryoablative bi-atrial Cox-Maze III (group B) in 25 patients. This additional procedure took only an extra 10 min for group A and about 20 min for group B. Half of the patients received a beta-blocker following the procedure.
  
  
  RESULTS
  The overall success rate of cryoablation was 65.5%. Normal sinus rhythm was achieved in 26.7% in the operating room, 10% in ICU and the remaining cases reverted to sinus rhythm during the follow-up period. There were no major ablation-related complications such as bleeding, thromboembolic events or A-V block. The only predictor for failure of ablative procedure was left atrial size of greater than 6 cm.
  
  
  CONCLUSIONS
  Although in this study the efficacy rate of cryoablative surgery was not the same as classical Cox-Maze III, it seems that this procedure is safe, simple, cost-effective and at the same time does not increase the operative time significantly. Using cryoablation may enhance the cure rate of chronic AF during mitral valve surgery.
authors.affiliation: Department of Cardiovascular Surgery, Rajaee Heart Centre, Vali e Asr Avenue, Tehran, Iran. aaghavidel@yahoo.com
authors.forename: Alireza Alizadeh
authors.initials: AA
authors.lastname: Ghavidel
authors.forename: Hossein
authors.initials: H
authors.lastname: Javadpour
authors.forename: Massoud
authors.initials: M
authors.lastname: Shafiee
authors.forename: Mohammad-Bagher
authors.initials: MB
authors.lastname: Tabatabaie
authors.forename: Kamal
authors.initials: K
authors.lastname: Raiesi
authors.forename: Saeed
authors.initials: S
authors.lastname: Hosseini
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000473:pathology / Q000601:surgery*; D002908:Chronic Disease; D003452:Cryosurgery / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D011182:Postoperative Care / Q000379:methods; D011379:Prognosis; D017211:Treatment Failure