HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Stefano Benussi Simona Nascimbene Zvi Ziskind Ottavio Alfieri Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Benussi, S. Articles by Alfieri, O. Search for Related Content PubMed PubMed Citation Articles by Benussi, S. Articles by Alfieri, O. Related Collections Valve disease

J Thorac Cardiovasc Surg 2005;130:491-497
© 2005 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Surgical ablation of atrial fibrillation with a novel bipolar radiofrequency device

^a Division of Cardiac Surgery, S Raffaele University Hospital, Milan, Italy
^b Epidemiology Unit, S Raffaele University Hospital, Milan, Italy
^c Division of Arrhythmology, S Raffaele University Hospital, Milan, Italy

Received for publication September 29, 2004; revisions received January 10, 2005; accepted for publication January 13, 2005.

^_* Address for reprints: Stefano Benussi, MD, PhD, Division of Cardiac Surgery, S Raffaele University Hospital, via Olgettina 60, 20132 Milan, Italy (Email: stefano.benussi{at}hsr.it).

OBJECTIVE: When used for epicardial ablation, unipolar devices do not predictably yield transmural scars. Bipolar radiofrequency proved highly effective on the animal model, but clinical experience is still initial. We describe acute electrophysiologic findings and follow-up results of epicardial ablation with a novel bipolar radiofrequency device.

METHODS: A bipolar ablator was used to perform a simplified left atrial lesion set in 90 consecutive patients with atrial fibrillation undergoing open heart surgery. Pacing thresholds were assessed during surgery to validate 24 pulmonary vein encircling lines (12 patients). Follow-up was 100% complete.

RESULTS: In 67 of 90 patients (84%), mitral valve disease was the main indication to surgery. Atrial fibrillation was continuous in 74 patients (82%) and intermittent in 16 patients (18%). Pacing threshold assessment showed a complete conduction block in 22 of 24 pulmonary vein couples (92%) after a single ablation and in all patients after doubling of the encircling lines. No complications related to the ablation procedure were recorded. The sinus rhythm restoration rate was 79% at 3 months, 87% at 6 months, and 89% (17/18 patients) at 1 year. Postablation organized arrhythmias consisted in right atrial flutter in 2 patients (2%) and left atrial flutter in 6 patients (7%).

CONCLUSIONS: Epicardial ablation with bipolar radiofrequency grants acute transmurality. A simplified lesion set proved highly effective in eliminating atrial fibrillation at 1-year follow-up. Our data suggest that addition of a lesion to the mitral annulus is advisable to prevent left atrial flutter.

This article has been cited by other articles:

				S. Benussi, S. Nascimbene, A. Galanti, A. Fumero, E. Dorigo, V. Zerbi, M. Cioni, and O. Alfieri Complete left atrial ablation with bipolar radiofrequency Eur. J. Cardiothorac. Surg., April 1, 2008; 33(4): 590 - 595. [Abstract] [Full Text] [PDF]

				A.M. Patwardhan Intraoperative ablation of atrial fibrillation using bipolar output of surgical radiofrequency generator (diathermy) and reusable bipolar forceps J. Thorac. Cardiovasc. Surg., June 1, 2007; 133(6): 1683 - 1683. [Full Text] [PDF]

				S. Benussi, S. Nascimbene, and O. Alfieri Reply to the Editor J. Thorac. Cardiovasc. Surg., June 1, 2007; 133(6): 1683 - 1684. [Full Text] [PDF]

				J. M. Stulak, T. M. Sundt III, J. A. Dearani, R. C. Daly, T. A. Orsulak, and H. V. Schaff Ten-year Experience With the Cox-Maze Procedure for Atrial Fibrillation: How Do We Define Success? Ann. Thorac. Surg., April 1, 2007; 83(4): 1319 - 1324. [Abstract] [Full Text] [PDF]

				S. Martin-Suarez, B. Claysset, L. Botta, M. Ferlito, D. Pacini, C. Savini, G. Marinelli, and R. DiBartolomeo Surgery for atrial fibrillation with radiofrequency ablation: four years experience Interactive CardioVascular and Thoracic Surgery, February 1, 2007; 6(1): 71 - 76. [Abstract] [Full Text] [PDF]

				I. Bakir, F. P. Casselman, P. Brugada, P. Geelen, F. Wellens, I. Degrieck, F. Van Praet, Y. Vermeulen, R. De Geest, and H. Vanermen Current Strategies in the Surgical Treatment of Atrial Fibrillation: Review of the Literature and Onze Lieve Vrouw Clinic's Strategy Ann. Thorac. Surg., January 1, 2007; 83(1): 331 - 340. [Abstract] [Full Text] [PDF]

				S. Benussi and O. Alfieri Off-pump connection of the pulmonary veins with bipolar radiofrequency: Toward a complete epicardial ablation J. Thorac. Cardiovasc. Surg., July 1, 2006; 132(1): 177 - 178. [Full Text] [PDF]

				S. Benussi and O. Alfieri Concomitant ablation of atrial fibrillation during mitral surgery MMCTS, November 29, 2005; 2005(1129): 1081. [Abstract] [Full Text] [PDF]