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J Thorac Cardiovasc Surg 2008;136:1156-1159
© 2008 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Long-term results after ablation for long-standing atrial fibrillation concomitant to surgery for organic heart disease: Is microwave energy reliable?

Calin Vicol, MD*, Diana Kellerer, MS, Paraskevi Petrakopoulou, MD, Ingo Kaczmarek, MD, Peter Lamm, MD, Bruno Reichart, MD

Department of Cardiac Surgery, Großhadern Medical Center, Ludwig Maximilian University Munich, Munich, Germany

Received for publication October 25, 2007; revisions received February 22, 2008; accepted for publication May 9, 2008.

* Address for reprints: Calin Vicol, MD, Herzchirurgische Klinik, Klinikum der Universität München, Campus Großhadern, Marchioninistr. 15, 81377 München, Germany. (Email: Calin.Vicol{at}med.uni-muenchen.de).

Objective: Microwave ablation has been reported as efficient for the surgical treatment of long-standing atrial fibrillation. However, the influence of ablation lesions on long-term results is not known.

Methods: From August of 2000 to November of 2003, 41 patients underwent a left atrial endocardial microwave ablation procedure after a Cox-Maze–like lesion set for long-standing atrial fibrillation concomitant to surgery for valvular or coronary artery disease. Mitral valve surgery alone or combined was performed in 31 cases (75.6%). The mean diameter of the left atrium was 7.19 ± 1.44 cm. The mean duration of preoperative atrial fibrillation was 4.7 ± 3.6 years. Patient follow-up was conducted by means of direct clinical examination, electrocardiography, and transthoracic echocardiography. The mean follow-up was 5.37 ± 0.91 years.

Results: Patient follow-up was achieved in 82% of cases (n = 28). Seven patients (17%) died during follow-up. Stroke was the cause of death in 1 patient with persistence of atrial fibrillation. Major complications occurred in 4 (14.3%) of the patients that were related to the persistence of atrial fibrillation. At 5 years follow-up, 39.3% of patients (11/28) were in sinus rhythm. Seventeen patients (60.7%) were in New York Heart Association classes I and II, and 11 patients (39.3%) were in New York Heart Association class III at the time of follow-up.

Conclusion: In our experience, left atrial endocardial microwave ablation for long-standing atrial fibrillation after a Cox-Maze–like ablation lesion set during surgery for organic heart disease is not a reliable method of achieving long-term conversion to sinus rhythm.

Abbreviations and Acronyms AF = atrial fibrillation; ECG = electrocardiogram; NYHA = New York Heart Association






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