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Right arrow Electrophysiology - arrhythmias

J Thorac Cardiovasc Surg 2002;123:919-927
© 2002 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease (ACD)

Curative treatment of atrial fibrillation with intraoperative radiofrequency ablation: Short-term and midterm results

Friedrich W. Mohr, MD, PhDa, Alexander M. Fabricius, MDa, Volkmar Falk, MD, PhDa, Rüdiger Autschbach, MD, PhDa, Nicolas Doll, MDa, Ulrich von Oppell, MD, PhDa, Anno Diegeler, MD, PhDa, Hans Kottkamp, MD, PhDb, Gerd Hindricks, MD, PhDb

From the Divisions of Cardiac Surgerya and Cardiology,b Herzzentrum, University of Leipzig, Leipzig, Germany.

Received for publication May 15, 2001. Revisions requested June 25, 2001; revisions received Aug 2, 2001. Accepted for publication Aug 8, 2001. Address for reprints: Friedrich W. Mohr, MD, PhD, Abteilung für Herzchirurgie, Herzzentrum Leipzig, Russenstrasse 19, D-04289 Leipzig, Germany (E-mail: mohrf{at}medizin.uni-leipzig.de).

Objective: This report describes the early and midterm results after intraoperative radiofrequency ablation of atrial fibrillation for patients with isolated chronic atrial fibrillation or atrial fibrillation in combination with additional valvular and nonvalvular cardiac diseases.
Methods: From August 1998 to March 2001, a total of 234 patients with chronic atrial fibrillation underwent isolated intraoperative radiofrequency ablation alone (n = 74, 31.6%) or in combination with other cardiac procedures, such as mitral valve reconstruction (n = 57, 24.4%), mitral valve replacement (n = 38, 16.2%), aortic valve replacement (n = 11, 5.1%), coronary artery bypass grafting (n = 8, 5.0%), or a combination of the last with other cardiac procedures (n = 46, 19.7%). In all cases anatomic reentrant circuits confined within the left atrium were eliminated by placing contiguous lesion lines involving the mitral anulus and the orifices of the pulmonary veins through the use of radiofrequency energy application (exposure time, 20 seconds). A median sternotomy was used in 101 cases (43.2%), and video assistance through a right lateral minithoracotomy was used in 133 cases (56.8%).
Results: A total of 188 patients (83.9%) were discharged in sinus rhythm, 17 patients (7.6%) had atrial fibrillation, and 19 patients (8.5%) had atypical flutter. Pacemakers were implanted in 23 patients (9.8%). There were 10 in-hospital deaths (4.2%), and 30-day mortality was 5 patients (2.1%). In 3 cases (1.3%) an atrioesophageal fistula developed, necessitating surgical repair. Six months' follow-up was complete for 122 (61.0%) of 200 patients, with 99 patients still in stable sinus rhythm (81.1%, 95% confidence interval 73.1%-89.9%). Twelve months' follow-up was complete for 80 (90.9%) of 88 patients, with 58 patients still in sinus rhythm (72.5%, 95% confidence interval 61.3%-83.2%).
Conclusions: Intraoperative radiofrequency ablation is a curative procedure for chronic atrial fibrillation. It is technically less challenging than the maze procedure and can be applied through a minimally invasive approach. Protection of the esophagus seems mandatory to avoid the deleterious complication of a left atrioesophageal fistula, such as was observed in 3 cases.




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