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J Thorac Cardiovasc Surg 2007;133:1027
© 2007 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Discussion

Dr Cliff K. Choong (Cambridge, United Kingdom). Among the patients who underwent the RF ablation, did you and your co-investigators do any intraoperative assessment to confirm transmurality of the ablation lines at all? Second, why do you think there is a difference in these results between the two groups? Last, on the basis of your findings, how has that influenced the practice at the Mayo Clinic?

Dr Stulak. Intraoperatively, it seemed in this patient population that RF was used mostly in patients who had numerous concomitant procedures. Because it is very time-consuming, we do not measure conduction block intraoperatively. It is hard to know why we saw the striking differences between the two procedures that we did. It is hard to know whether it is purely due to a potential lack of transmurality. There are numerous factors that may contribute, including differences in the atrial characteristics in terms of thickness, fibrotic scar in older patients, the amount of fat around the pulmonary veins, as well as intraoperative factors such as normothermia versus hypothermia, beating heart, endocardial versus epicardial. We think that it is impossible to apply uniform energy in a uniform fashion to atria that have very different characteristics. In our practice, although we believe that RF can be used as part of a concomitant procedure, if . . . [Full Text of this Article]

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Superiority of cut-and-sew technique for the Cox maze procedure: Comparison with radiofrequency ablation

John M. Stulak, Joseph A. Dearani, Thoralf M. Sundt, III, Richard C. Daly, Christopher G.A. McGregor, Kenton J. Zehr, and Hartzell V. Schaff
J. Thorac. Cardiovasc. Surg. 2007 133: 1022-1027. [Abstract] [Full Text] [PDF]