title: Adjunctive surgical atrial fibrillation ablation during cardiac surgery: real life experiences.
abstract: OBJECTIVE
  Several tools have been invented for surgical atrial fibrillation (AF) ablation. In this study, we investigated the real world efficacy of intraoperative AF ablation (AFA) with radiofrequency-energy or cryo-ablation and performed an electro-anatomical remap in some patients with recurrences.
  
  
  METHODS
  Seventy-three consecutive patients (53 male, median age of 69 ± 7 years) with history of AF underwent cardiac surgery for valve repair (74 % mitral defects, 60 % aortic defects) and/or coronary artery bypass graft procedures (56 %). During a follow-up of 23 ± 11 months after AFA we performed intensified holter-monitoring (4-7 days). Patients with symptomatic relapse of atrial arrhythmias (AA) were offered the opportunity for additional electrophysiological examination (EPE).
  
  
  RESULTS
  During 23 ± 11 months after AFA, 45 patients (62 %) had recurrent AA. In eight patients we performed EPE. In all 8 cases, septal circumferential lesions could be demonstrated during mapping with discrete gaps. All lateral veins were isolated however, posteriorly deep inside the vein leaving the antral region completely untreated. Neither roof lines nor mitral isthmus lines were complete. Performing catheter ablation, all veins could be isolated and seven patients were free of any arrhythmias during follow up (9 ± 5 months) without taking antiarrhythmic drugs.
  
  
  CONCLUSIONS
  Surgical AF ablation may often be incomplete rendering sobering results in unselected patients. Completion of the ablation is feasible with catheter ablation with good clinical outcome.
authors.affiliation: Heart Center Rostock (Cardiology) University Hospital of Rostock, Ernst-Heydemann-Str. 6, 18057, Rostock, Germany, dietmar.baensch@med.uni-rostock.de.
authors.forename: T S
authors.initials: TS
authors.lastname: Tischer
authors.forename: R
authors.initials: R
authors.lastname: Schneider
authors.forename: J
authors.initials: J
authors.lastname: Lauschke
authors.forename: C
authors.initials: C
authors.lastname: Nesselmann
authors.forename: G
authors.initials: G
authors.lastname: Steinhoff
authors.forename: Dietmar
authors.initials: D
authors.lastname: Bänsch
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D016896:Treatment Outcome