Cryoablation for surgical treatment of chronic atrial fibrillation combined with mitral valve surgery: a clinical observation.
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.
Ghavidel
Alireza Alizadeh
AA
Department of Cardiovascular Surgery, Rajaee Heart Centre, Vali e Asr Avenue, Tehran, Iran. aaghavidel@yahoo.com
Javadpour
Hossein
H
Shafiee
Massoud
M
Tabatabaie
Mohammad-Bagher
MB
Raiesi
Kamal
K
Hosseini
Saeed
S
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