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J Thorac Cardiovasc Surg 2006;132:177-178
© 2006 The American Association for Thoracic Surgery

Brief Communication

Off-pump connection of the pulmonary veins with bipolar radiofrequency: Toward a complete epicardial ablation

Division of Cardiac Surgery, S Raffaele University Hospital, Milan, Italy

Received for publication January 12, 2006; revisions received February 17, 2006; accepted for publication March 7, 2006.

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

The first 20% of the full text of this article appears below.

Although bipolar radiofrequency is presently the most reliable means to create transmural atrial scars, ^1-3 the clamping design of bipolar devices has limited its epicardial use to pulmonary vein (PV) isolation.

We describe a technique to perform a posterior left atrial connection (PLAC) between the 2 PV-encircling ablations epicardially, off-pump with a standard bipolar radiofrequency device.

Technique

The ablation technique is here described in a series of patients undergoing concomitant off-pump coronary artery bypass (OPCAB) surgery.

After median sternotomy and harvesting of the conduits, the pericardium is incised and suspended as for standard OPCAB. Heparin is administered. All grafts are completed during suction stabilization. Apical suction is used to enhance exposure. The left internal thoracic artery graft is tailored long enough to allow rightward displacement of the heart.

The ablations are performed with a bipolar radiofrequency device (Cobra Bipolar; Estech Inc, San Ramon, Calif), with the 64-mm-long ablating inserts mounted on a straight clamp. Radiofrequency energy is delivered for 40 seconds at 90°C. All ablations are doubled to ensure electrical block. ²

Dissection of the reflections is begun around the right PVs after developing the Waterston groove. To prepare the . . . [Full Text of this Article]

This article has been cited by other articles:

				M. A. Mariani, T. Stoker, M. F. Scholten, A. Addis, D. Corradi, O. Alfieri, and S. Benussi Concomitant Off-Pump Modified Maze and Coronary Surgery Ann. Thorac. Surg., June 1, 2011; 91(6): e96 - e98. [Abstract] [Full Text] [PDF]

				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]