Cryoablation for surgical treatment of chronic atrial fibrillation combined with mitral valve surgery: a clinical observation

Ghavidel, Alireza Alizadeh; Javadpour, Hossein; Shafiee, Massoud; Tabatabaie, Mohammad-Bagher; Raiesi, Kamal; Hosseini, Saeid

doi:10.1016/j.ejcts.2008.03.019

Cited by 26 publications

(30 citation statements)

References 23 publications

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“…However, in patients with small left atria (≤ 5cm) and lone paroxysmal AF, our center and others have had good results with pulmonary vein isolation, and this is a reasonable procedure that can be performed off CPB. In patients undergoing valve surgery, we have preferred a full CMP lesion set since the results of pulmonary vein isolation in these patients have generally been poor29, 33–36. Moreover, surgically converting AF into sinus rhythm has been associated with better early and late survival and less thromboembolic events during follow-up for patients with mitral valve disease37–40.…”

Section: Discussionmentioning

confidence: 99%

A Minimally Invasive Cox-Maze Procedure Operative Technique and Results

Lee

Clark

Bailey

et al. 2010

Innovations�(Phila)

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Objective The Cox-Maze procedure (CMP) for the surgical treatment of atrial fibrillation (AF) traditionally has required a median sternotomy and cardiopulmonary bypass. This study describes a method using ablation technologies to create the full Cox-Maze lesion set through a 5- to 6-cm right minithoracotomy. Methods Twenty-two consecutive patients underwent a CMP through a right mini-thoracotomy and cardiopulmonary bypass. All patients were followed prospectively with electrocardiogram and 24-hour Holter monitoring at 3, 6, and 12 months. The CMP lesion set was created using bipolar radiofrequency energy and cryotherapy. Results There was no operative mortality or major complications. Two patients required a permanent pacemaker. Five patients (23%) had early atrial tachyarrhythmias. At last follow-up (mean, 18 ± 12 months), all the patients (n = 22) were free from atrial dysrhythmias. At 3 months (n = 19), 84% of patients were off antiarrhythmic drugs. At 6 months (n = 18), 94% of patients were free from AF and off antiarrhythmic medications. At 12 months (n = 16), 81% of patients were free from AF and off antiarrhythmic drugs and three patients remained on warfarin for a mechanical mitral valve. Conclusions A full CMP can be performed through a right mini-thoracotomy with outstanding short-term results. This less invasive procedure can be offered to patients without compromising efficacy.

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Section: Discussionmentioning

confidence: 99%

A Minimally Invasive Cox-Maze Procedure Operative Technique and Results

Lee

Clark

Bailey

et al. 2010

Innovations�(Phila)

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“…All nine papers were either small randomised controlled trials or retrospective studies with small sample sizes (57-521) and varied follow-up regimens. Six of nine studies [2,[4][5][6][7][8] suggested that cryoablation is most successful in patients suffering from paroxysmal rather than permanent AF. A lack of 24-hour monitoring in seven of nine studies [2-6, 9, 10] prevents effective elucidation of the rate of paroxysmal AF following cryoablation.…”

Section: Clinical Bottom Linementioning

confidence: 98%

“…Ghavidel et al [5] examined the use of cryoablation in either generating a Cox-Maze III pattern or in pulmonary vein isolation (PVI). They showed that there was no significant difference between the patterns in return to SR during 12-month follow-up.…”

Section: Search Outcomementioning

confidence: 99%

How effective is cryoablation for atrial fibrillation during concomitant cardiac surgery?

Camm¹,

Nagendran²,

Xiu³

et al. 2011

Interactive CardioVascular and Thoracic Surgery

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A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether performing cryoablative procedures during concomitant cardiac surgical procedures is effective for the treatment of atrial fibrillation (AF). Altogether 291 papers were found using the reported search, of which nine represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. All studies showed that cryoablation during concomitant surgery had a significant effect on return to sinus rhythm (SR) conversion rate. One study showed that cryoablation was significantly more effective than mitral valve surgery alone at a 12-month follow-up (73.3% vs. 42.9%, respectively, P=0.013). The use of a concomitant cryoablative procedure has also been shown to be far superior to subsequent catheter based cryoablation in returning patients to SR at a 12-month follow-up (82% and 55.2%, respectively, P<0.001). Another study showed a significant return to AF over a three-year period (91.8% and 84.1% at discharge and three years, respectively). Return to SR was significantly decreased in those patients suffering from permanent rather than paroxysmal AF (47% vs. 85%, P<0.001). Paucity of level 1 evidence was a major limitation to this analysis. All nine papers were either small randomised controlled trials or retrospective studies with small sample sizes (57-521) and varied follow-up regimens. Six of nine studies suggested that cryoablation is most successful in patients suffering from paroxysmal rather than permanent AF. A lack of 24-h monitoring in seven of nine studies prevented effective elucidation of the rate of paroxysmal AF following cryoablation. Only one study suggested an increased complication rate from cryoablation, however, none suggested any negative impact on mortality or morbidity. We conclude that cryoablation during concomitant surgery is a safe and acceptable intervention for the treatment of AF with an SR conversion rate of between 60% and 82% at 12-months postsurgery.

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“…Ghavidel et al [22] used nitrous-based cryothermia energy on a group (n ¼ 90) who underwent surgical ablation (n ¼ 65 pulmonary vein isolation; n ¼ 25 biatrial Cox Maze) at the same time as their mitral valve surgery. They found that 65.5% of the patients were in SR at 12 months.…”

Section: Valvular Heart Diseasementioning

confidence: 99%