Three years experience with monopolar and bipolar radiofrequency ablation surgery in patients with permanent atrial fibrillation

• Published in: European journal of cardio-thoracic surgery 2005-02, Vol.27 (2), p.243-249
• Main Authors: Geidel, Stephan, Ostermeyer, Jörg, Lass, Michael, Betzold, Matthias, Duong, Anh, Jensen, Folke, Boczor, Sigrid, Kuck, Karl-Heinz
• Format: Article
• Language: English
• Subjects: Aged; Aortic Valve - physiopathology; Aortic Valve - surgery; Arrhythmia surgery; Atrial fibrillation; Atrial Fibrillation - mortality; Atrial Fibrillation - physiopathology; Atrial Fibrillation - surgery; Bipolar radiofrequency ablation; Catheter Ablation - adverse effects; Catheter Ablation - methods; Female; Heart Valve Diseases - mortality; Heart Valve Diseases - physiopathology; Heart Valve Diseases - surgery; Heart valve surgery; Humans; Male; Mitral Valve - physiopathology; Mitral Valve - surgery; Prospective Studies; Radiofrequency ablation; Recurrence; Treatment Outcome
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2004.10.046

Objective: In our population permanent atrial fibrillation (pAF) is a frequent concomitant problem in patients undergoing open heart surgery. A 3-year experience with a treatment strategy using mono- and bipolar radiofrequency (RF) ablation procedures in a heterogeneous group of patients is reported. Methods: In a prospective analysis the incidence of pAF among all patients undergoing open heart surgery in our department between February 2001 and July 2004 was evaluated. In a second step a selective group of 106 patients with pAF (primary mitral: n=63; aortic: n=24; CABG: n=16; aortic+mitral: n=3) underwent either monopolar (n=86) or bipolar (n=20) RF ablation procedures creating two encircling isolation lesions around the left and the right pulmonary veins (PVs) and a connection line between both. In addition amiodarone was given for 3 months after surgery. Regular follow-ups were performed 3, 6, 9, 12, 18, 24 and 36 months after surgery. Results: The incidence of pAF in the total group of 4.110 patients was 3.6%. While the rate was low in cases without severe heart valve disease (1.1%), a significantly higher presence of pAF in patients scheduled for heart valve surgery (10.3%) was observed (P≪0.0001). The incidence was 30–39% in patients with degenerative and rheumatic mitral valve (MV) disease, and further particularly high in the older aged compared to younger patients (4.2–8.3% at 70–99 years; P≪0.001). Hospital mortality after combined open heart and RF ablation surgery was 1.9%. Whereas patients with small left atrial size (LA-diameters ≪56mm; n=59) had SR in almost 90% at follow-up, LA enlargement (LA-diameter ≧56mm; n=47) was associated with a significant risk of persisting pAF after surgery (P=0.033, 0.002 and 0.006 at 3, 6 and 9 months follow-up). Conclusion: The use of RF ablation procedures in combination with amiodarone therapy represents a safe and efficient option to cure pAF during open heart surgery in a selective group of patients. The preoperative LA size was of significant importance for the outcome in this investigation.