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J Thorac Cardiovasc Surg 2007;133:1683
© 2007 The American Association for Thoracic Surgery

Letter to the Editor

Intraoperative ablation of atrial fibrillation using bipolar output of surgical radiofrequency generator (diathermy) and reusable bipolar forceps

A.M. Patwardhan, MD

CVTS Department, Seth G.S.Medical College and K.E.M. Hospital, Parel, Mumbai, India

To the Editor:

My colleagues and I began using bipolar radiofrequency (RF) ablation in August 1996 and published the first clinical study in the European Journal of Cardio-thoracic Surgery.1Go We used the standard bayonet-shaped bipolar forceps with a 7-mm tip to draw ablation lines, which replaced most of the incisions of the Cox maze III procedure. The larger experience with this technique was published in Heart, Lung and Circulation.2Go

A number of bipolar RF ablation devices have been used experimentally and clinically. The results of these studies have been published in this Journal. One such study is that by Gaynor and associates.3Go They tried to do exactly what we described in our publication in an indexed journal. Similarly, Gillinov and coworkers4Go have used bipolar RF with different lesion sets. In addition, our letter to Editor5Go clearly defines the advantage of bipolar RF over unipolar RF in avoiding collateral damage. In the abstract to the article by Benussi and associates,6Go the "Objective" section states, "Bipolar radiofrequency proved highly effective in the animal model, but clinical experience is still initial."

I am at a loss to understand the reasons for the omission, in this Internet era, of reference to our original work published much earlier. I am absolutely sure that this omission was not intentional, yet I am led to believe it is a scientific lapse.

Therefore, I believe it would be appropriate to bring to the notice of the readers that intraoperative ablation of atrial fibrillation with bipolar RF is possible with a good success rate without additional costs of special RF equipment and disposable bipolar clamps. The technique is described in detail in reference 2Go. It is the purpose of this letter to highlight the fact that the standard RF generator with bipolar output can be used with the bayonet-shaped bipolar forceps to effect ablation lines on the atria and achieve a success similar to that of modified maze procedures. Our ongoing work, begun 10 years, ago emphasizes that our approach is highly successful, simple, and eminently cost-effective.

References

  1. Patwardhan AM, Dave HH, Tamhane AA, Pandit SP, Dalvi BV, Golam K, et al. Intraoperative radiofrequency microbipolar coagulation to replace incisions of maze III procedure for correcting atrial fibrillation in patients with rheumatic valvular disease. Eur J Cardiothorac Surg 1997;12:627-633.[Abstract/Free Full Text]
  2. Lad VS, Patwardhan AM. Maze III replication using radiofrequency microbipolar coagulation. Heart Lung Circ 2004;13:139-144.[Medline]
  3. Gaynor SL, Diodato, MD, Prasad SM, Ishii Y, Schuessler RB, Bailey MS, et al. A prospective single-center clinical trial of a modified Cox maze procedure with bipolar radiofrequency ablation. J Thorac Cardiovasc Surg 2004;128:535-542.[Abstract/Free Full Text]
  4. Gillinov AM, McCarthy PM, Blackstone EH, Rajeswaran J, Pettersson G, Sabik III JF, et al. Surgical ablation of atrial fibrillation with bipolar radiofrequency as the primary modality. J Thorac Cardiovasc Surg 2005;129:1322-1329.[Abstract/Free Full Text]
  5. Patwardhan AM, Lad VS, Pai V. Esophageal injury during radiofrequency ablation for atrial fibrillation: inherent safety of radiofrequency bipolar coagulation (letter). J Thorac Cardiovasc Surg 2002;124:642.[Free Full Text]
  6. Benussi S, Nascimbene S, Calori G, Denti P, Ziskind Z, Kassem S, et al. Surgical ablation of atrial fibrillation with a novel bipolar radiofrequency device. J Thorac Cardiovasc Surg 2005;130:491-497.[Abstract/Free Full Text]

Related Article

Reply to the Editor
Stefano Benussi, Simona Nascimbene, and Ottavio Alfieri
J. Thorac. Cardiovasc. Surg. 2007 133: 1683-1684. [Extract] [Full Text] [PDF]




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