Intra-operative cooled-tip radiofrequency linear atrial ablation to treat permanent atrial fibrillation

Aims To demonstrate the safety and efficacy of saline irrigated cooled-tip atrial linear endocardial radiofrequency ablation (SICTRA) concomitant to open-heart surgical procedures in the treatment of permanent atrial fibrillation (AF). Methods and Results Two hundred and twenty-two patients presenti...

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Bibliographic Details
Published in:European heart journal 2007-12, Vol.28 (23), p.2909-2914
Main Authors: Deneke, Thomas, Khargi, Krishna, Lemke, Bernd, Lawo, Thomas, Lindstaedt, Michael, Germing, Alfried, Brodherr, Turgut, Bösche, Leif, Mügge, Andreas, Laczkovics, Axel, Grewe, Peter H., Fritz, Markus
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Anti-atrial fibrillation surgery
Antiarrhythmic surgery
Antiarythmic agents
Aortic Valve - transplantation
Atrial Fibrillation - mortality
Atrial Fibrillation - surgery
Biological and medical sciences
Cardiac dysrhythmias
Cardiology. Vascular system
Cardiovascular system
Catheter Ablation - instrumentation
Catheter Ablation - methods
Combined Modality Therapy - methods
Coronary Artery Bypass - methods
Follow-Up Studies
Heart
Humans
Intra-operative endocardial ablation of atrial fibrillation
Intraoperative Period
Medical sciences
Middle Aged
Mitral Valve - surgery
Other treatments
Permanent atrial fibrillation
Pharmacology. Drug treatments
Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)
Treatment. General aspects
Tumors
Citations: Items that cite this one
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Summary:Aims To demonstrate the safety and efficacy of saline irrigated cooled-tip atrial linear endocardial radiofrequency ablation (SICTRA) concomitant to open-heart surgical procedures in the treatment of permanent atrial fibrillation (AF). Methods and Results Two hundred and twenty-two patients presenting with permanent AF and the need for cardiac surgery were included. In addition to the cardio-surgical procedure [mitral valve (MV) surgery (n = 94), aortic valve replacement (n = 29), bypass surgery (n = 76 including 24 patients with additional MV surgery), and combined procedures (n = 23)] concomitant SICTRA was performed. In 116 patients, the ablation pattern was restricted to the left atrium alone. During the mean follow-up of 29 months, 174 patients (78%) converted to sinusrhythm (SR). In patients with SICTRA restricted to the left atrium conversion rates were not different compared to a biatrial approach (83 vs. 74%, P = 0.47). Thirty-days mortality was found to be 4% (9/222). Post-mortem evaluation revealed 23% of all lesions to be histologically non-transmural. In the overall group, only 4% of patients developed sustained secondary regular atrial arrhythmia. Conclusions SICTRA safely and effectively restores stable SR in 78% of patients with permanent AF undergoing open-heart surgery. Rhythm outcome is not influenced by treatment of the right atrium. Sustained regular atrial arrhythmia with the need for invasive treatment strategies occurs in 4% although intra-operative ablation lesions are often non-transmural.
ISSN:0195-668X
1522-9645
DOI:10.1093/eurheartj/ehm397