Comparison of Surgical Cut and Sew versus Radiofrequency Pulmonary Veins Isolation for Chronic Permanent Atrial Fibrillation: A Randomized Study

• Published in: Pacing and clinical electrophysiology 2010-10, Vol.33 (10), p.1249-1257
• Main Authors: PIRES, LEONARDO M., LEIRIA, TIAGO L. L., De LIMA, GUSTAVO G., KRUSE, MARCELO L., NESRALLA, IVO A., KALIL, RENATO A. K.
• Format: Article
• Language: English
• Subjects: Aged; Amiodarone - therapeutic use; Anti-Arrhythmia Agents - therapeutic use; atrial fibrillation; Atrial Fibrillation - drug therapy; Atrial Fibrillation - surgery; Biological and medical sciences; Cardiac dysrhythmias; Cardiology. Vascular system; Catheter Ablation - methods; Chronic Disease; Electrophysiology; Female; Fibrillation; Heart; heart surgery; Heart Valve Diseases - drug therapy; Heart Valve Diseases - surgery; Humans; Lung; Male; Medical sciences; Middle Aged; Mitral valve; Mitral Valve - surgery; pulmonary veins; Pulmonary Veins - surgery; radiofrequency; Recurrence; Rhythms; Sinus; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; surgery for arrhythmias; Surgery of the heart; Treatment Outcome; Veins
• ISSN: 0147-8389; 1540-8159
• DOI: 10.1111/j.1540-8159.2010.02805.x

Background: Surgical pulmonary veins isolation (PVI) is done to restore sinus rhythm (SR) in patients with chronic permanent atrial fibrillation (CPAF) and mitral valve disease. Here we compare the efficacy of electrical block lines performed with radiofrequency (RF) compared with conventional surgery. Methods: Randomized trial of 22 patients with CPAF and indication for mitral valve surgery. Ten patients underwent conventional surgery (SURG) and 12 RF. To prove the efficacy of the blockage lines, epicardial pacemaker wires were placed in the isolated pulmonary veins region (IPVR) and right atria (RA). Results: There were no differences in the baseline data among the groups. All patients remained in SR during the immediate postoperative period. Block lines were tested in patients who remained in SR during the following days (eight in SURG and nine in RF). The median value of thresholds to conduct the stimulus of IPVR for the RA was 18 mA in SURG and 3 mA in RF (P < 0.022). Eight SURG patients and seven RF patients (P < 0.38) remained in SR at hospital discharge. Eleven RF patients and one SURG required amiodarone to maintain SR (P < 0.001). The incidence of recurrent atrial fibrillation (AF) in the follow‐up was 10.7/100 patients/year in the SURG group versus 73.1/100 patients/year in the RF group (P = 0.009). Conclusions: PVI by SURG formed more effective block lines than RF. SR at hospital discharge was similar among the groups, but more amiodarone was used in RF. During follow‐up, incidence of recurrent AF was higher in the RF group. (PACE 2010; 33:1249–1257)