Left atrial versus bi-atrial maze operation using intraoperatively cooled-tip radiofrequency ablation in patients undergoing open-heart surgery

Deneke, Thomas; Khargi, Krishna; Grewe, Peter; Dryander, Stefan von; F, Kuschkowitz; Lawo, Thomas; Müller, Klaus‐Michael; Laczkovics, Axel; Lemke, Bernd

doi:10.1016/s0735-1097(02)01836-3

Cited by 99 publications

(57 citation statements)

References 24 publications

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“…36 The addition of right atrial lesions may increase freedom from recurrent AF and atrial flutter, but their importance is controversial. 37,38 However, creation of a right atrial isthmus lesion to reduce occurrence of atrial flutter is simple and safe, and we currently favor its incorporation at the time of surgical ablation.…”

Section: New Approaches For Surgical Af Ablationmentioning

confidence: 99%

Advances in the surgical treatment of atrial fibrillation

Gillinov

McCarthy

2004

Cardiology Clinics

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Abstract-Atrial fibrillation (AF) is the most common sustained arrhythmia. It is associated with increased risks of death and stroke; most strokes in AF patients are thought to arise from thrombi in the left atrial appendage. Surgical ablation of AF includes excision of the left atrial appendage and is an effective means of treating this arrhythmia, with the classic Maze procedure curing AF in Ͼ90% of patients and virtually eliminating the risk of late stroke. A complex but safe operation, the Maze procedure has been applied by relatively few surgeons. Key Words: ablation Ⅲ atrial fibrillation Ⅲ stroke A trial fibrillation (AF) currently affects Ϸ2.4 million Americans; this number is expected to increase to Ͼ5.6 million by 2050. 1 The prevalence of AF increases with increasing patient age, and recent data from the Framingham Heart Study suggest that the lifetime risks for development of AF are 1 in 4 for men and women aged Ն40 years. 2 This epidemic has a growing impact on the healthcare system and a multibillion dollar cost. The clinical consequences of AF are well documented. AF is associated with reduced life expectancy and increases the risk of stroke 5-fold, accounting for Ϸ15% of all strokes nationally. 3-8 These AF-related strokes are a major challenge and a focus of several clinical trials investigating strategies for primary and secondary prevention. 4 Currently, antithrombotic therapy is the mainstay for stroke prevention in AF patients.Although there is currently some consensus concerning pharmacological strategies for stroke prevention in AF patients, choice of therapy for the heart rhythm is controversial and evolving. 9,10 Available antiarrhythmic therapies inconsistently restore sinus rhythm and are associated with complications. In fact, the risks associated with antiarrhythmic drug therapy may counterbalance the potential benefit of restoration of sinus rhythm. 9,10 These observations, coupled with increased understanding of the pathogenesis of AF, have resulted in the development of interventional strategies to restore sinus rhythm. Both catheter-based and surgical approaches have demonstrated effectiveness in this regard. Developed by Dr James Cox, the classic Maze procedure is the predicate operation for ablation of AF; long-term data suggest that the Maze procedure eliminates AF in Ͼ90% of patients. 11-14 Despite these unmatched results, the complexity and time associated with the Maze procedure have prevented widespread application by surgeons.Recently, however, there has been increased interest in direct surgical ablation of AF, fueled by technological advances and demonstration that the pulmonary veins and left atrium are the drivers of AF in most patients. 15 New ablation technologies enable surgeons to perform pulmonary vein isolation, create strategically placed, linear left atrial lesions, and excise the left atrial appendage rapidly and safely. 16 -23 Alternate energy sources used to create lines of conduction block and replace surgical incisions of the Maze procedure include radio...

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Section: New Approaches For Surgical Af Ablationmentioning

confidence: 99%

Advances in the surgical treatment of atrial fibrillation

Gillinov

McCarthy

2004

Cardiology Clinics

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“…In addition, they have added that left atrium diameters > 80 mm represented a positive predictive factor in the recurrence of AF [1]. In 2007, Deneke et al [10] published a study comparing both radiofrequency techniques for treatment of AF and they were successful in reverting to sinus rhythm in 82% of biatrial cases and 75% in left atrium only, without statistical difference (P =0.571) between the two groups. The followup period of this study ranged from 1 to 50 months.…”

Section: Discussionmentioning

confidence: 99%

Avaliação inicial da ablação operatória biatrial por radiofrequência de fibrilação atrial

Breda¹,

Ragognette²,

Breda³

et al. 2010

Rev Bras Cir Cardiovasc

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Objective: The aim of this study is to evaluate the initial results of intraoperative radiofrequency ablation using biatrial procedure to treat chronic atrial fibrillation in patients with associated cardiac disease.Methods: Between February 2008 and May 2009, 15 consecutive patients were underwent mitral valve procedure plus modified radiofrequency biatrial ablation of chronic atrial fibrillation. The mean age was 47.73 ± 9.85 years and 60% were male. The mean left atrial diameter was 55.06 ± 7.56 mm.Results: There were no hospital mortality or complications related to radiofrequency ablation. The mean follow-up period was 7 ± 4 months. At the time of hospital discharge 9 (60%) patients were in sinus rhythm. After a mean follow-up period 11 (73.3%) were in sinus rhythm.Conclusion: Intraoperative biatrial radiofrequency ablation is a safe and effective technique for the treatment of chronic atrial fibrillation, with satisfactory midterms outcomes in terms of conversion to sinus rhythm. Bras Cir Cardiovasc 2010; 25(1): 45-50 Rev

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“…Similar protocols were used for several authors [16,25]. There is no consensus about the use of postoperative antiarrhythmics and anticoagulants regarding the time and previous conditions to be withdrawal.…”

Section: Discussionmentioning

confidence: 99%

Tratamento cirúrgico da fibrilação atrial crônica com eletrocautério convencional em cirurgia valvar mitral

Júnior¹,

Pontes²,

Gomes³

et al. 2008

Rev Bras Cir Cardiovasc

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Results: The mean time of extracorporeal circulation was 52.5 ± 13.3 min; aortic clamping, 35.6 ± 12.9 min; atrial ablation, 3.05 ± 0.16 min. All the patients were free of atrial fibrillation after the procedure; on hospital discharge, 69.5%; at 6 months, 91.3%; at 12 months, 76.4%; at 18 months, and at 24 months, 68.4%. At 12 months, left atrium mean diameter was 42.1 ± 3.5 mm; left ventricular ejection fraction was 59.2 ± 3.48%; In addition, left atrial contractility was present in 68.8% of the patients. 366GOMES JÚNIOR, JF ET AL -Surgical treatment of chronic atrial fibrillation with conventional electrocautery in mitral valve surgery Bras Cir Cardiovasc 2008; 23(3): 365-371 Rev

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Left atrial versus bi-atrial maze operation using intraoperatively cooled-tip radiofrequency ablation in patients undergoing open-heart surgery

Abstract: A left or bi-atrial Maze operation using intraoperatively cooled-tip RF ablation can safely be combined with open-heart surgery. A left atrial Maze procedure seems to be as effective as the bi-atrial procedure and restores SR in 82% of patients.

Cited by 99 publications

References 24 publications

Advances in the surgical treatment of atrial fibrillation

Advances in the surgical treatment of atrial fibrillation

Avaliação inicial da ablação operatória biatrial por radiofrequência de fibrilação atrial

Tratamento cirúrgico da fibrilação atrial crônica com eletrocautério convencional em cirurgia valvar mitral

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