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J Thorac Cardiovasc Surg 2007;134:982-988
© 2007 The American Association for Thoracic Surgery

Evolving Technology

Impact of beating heart left atrial ablation on left-sided heart mechanics

^a Division of Cardiac Surgery, University of Pittsburgh, Pittsburgh, Pa
^b Cardiovascular Institute, University of Pittsburgh, Pittsburgh, Pa
^c Medtronic, Inc, Minneapolis, Minn.

Received for publication December 4, 2006; revisions received March 29, 2007; accepted for publication April 9, 2007.

^_* Address for reprints: Marco A. Zenati, MD, Division of Cardiac Surgery, University of Pittsburgh, 200 Lothrop St, PUH C-700, Pittsburgh, PA 15213-2582. (Email: zenatim{at}upmc.edu).

Objective: The cut-and-sew Cox–Maze procedure is the gold standard for surgical treatment of atrial fibrillation, but it is associated with long-term impairment of left atrial mechanical function. We developed a bipolar, irrigated radiofrequency ablation device. We hypothesized that beating heart radiofrequency left atrial ablation would result in minimal acute changes in left atrial hemodynamics.

Methods: Six healthy subjects were studied. Combination pressure-conductance catheters were inserted into the left atrium and ventricle. With the use of the device, atrial ablation was performed on the beating heart without cardiopulmonary bypass, including electrical isolation of the posterior left atrium and atrial appendage myocardium. Simultaneous left-sided heart pressure–volume and intracardiac echocardiography data were acquired before ablation, after left atrial appendage ablation alone, and after all ablation (with and without appendage occlusion). The derived indices of left-sided heart mechanical function were examined.

Results: Relative to baseline, no significant diminishment in pressure–volume or intracardiac echocardiography-derived indices of global left-sided heart mechanical function were observed after ablation, with or without appendage occlusion. Mitral valve morphology and function were not significantly altered. A significant diminishment of atrial appendage systolic flow was noted after appendage ablation in association with spontaneous echocardiographic contrast in this region.

Conclusions: In this model, ablation does not seem to compromise global left-sided heart mechanical function. However, these findings mask regional diminishment in atrial appendage systolic function. This observation demonstrates that electrical isolation of the appendage should be accompanied by its occlusion or excision. Appendage occlusion after ablation does not seem to compromise left-sided heart mechanical function.

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