Randomized Trial of Concomitant Maze Procedure Using Nitrous Oxide- Versus Argon-Based Cryoablation

Jeong, Dong Seop; Sung, Kiick; Kim, Wook Sung; Cho, Carriere Keumhee; Park, Pyo Won

doi:10.1016/j.athoracsur.2019.01.005

Cited by 7 publications

(2 citation statements)

References 18 publications

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“…An observational study, with all its biases, reported better rhythm outcomes for the nitrous oxide probe compared to the argon one ( 46 ). In contrast, a recent randomized controlled trial showed no significant difference between the two probes at 1- ( 47 ) and 5-year ( 48 ) follow-up.…”

Section: Energy Sourcesmentioning

confidence: 73%

Surgical options for atrial fibrillation treatment during concomitant cardiac procedures

Baudo,

Rosati,

Lapenna

et al. 2024

Ann Cardiothorac Surg

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Current guidelines recommend concomitant surgical ablation (SA) of atrial fibrillation (AF) in the context of mitral valve disease. A variety of energy sources have been tested for SA to perform effective transmural lesions reliably. To date, only radiofrequency and cryothermy energies are considered viable options. The gold standard for SA is the Cox-Maze ablation set, especially for non-paroxysmal AF (nPAF), with the aim of interrupting macro-reentrant drivers perpetuating AF, without hampering the sinus node activation of both atria, and to maintain the atrioventricular synchrony. Although the efficacy of SA in terms of early and late sinus rhythm restoration has been clearly demonstrated over the years, concomitant AF ablation is still underperformed in patients with AF undergoing cardiac surgery. From a surgical standpoint, concerns have been raised about whether a single (left) or double atriotomy would be justified in AF patients undergoing a “non-atriotomy” surgical procedure, such as aortic valve or revascularization surgery. Thus, an array of simplified lesion sets have been described in the last decade, which have unavoidably hampered procedural efficacy, somewhat jeopardizing the standardization process of ablation surgery. As a matter of fact, the term “Maze” has improperly become a generic term for SA. Surgical interventions that do not align with the principles of forming conduction-blocking lesions according to the Maze pattern, cannot be classified as Maze procedures. In this complex scenario, a tailored approach according to the different AF patterns has been proposed: for patients with concomitant nPAF, a biatrial Cox-Maze ablation is recommended. Conversely, it might be reasonable to limit lesions to the left atrium or the pulmonary veins in patients with paroxysmal AF (PAF) in some clinical scenarios. The aim of this review is to provide an overview of the current ablation strategies for patients with AF undergoing concomitant cardiac surgery.

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Section: Energy Sourcesmentioning

confidence: 73%

Surgical options for atrial fibrillation treatment during concomitant cardiac procedures

Baudo,

Rosati,

Lapenna

et al. 2024

Ann Cardiothorac Surg

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“…Available cryo-ablation devices use nitrous oxide (N 2 0) or argon (Ar) gas as cooling agents. One small single-center randomized study showed a similar 1-year sinus rhythm maintenance rate using N 2 O-based cryo-ablation vs. Ar-based cryo-ablation in patients with persistent AF [ 28 ]. Another randomized trial showed that both N 2 O- and Ar-based cryoprobes provide similar rates of sinus rhythm maintenance and freedom from major adverse cardiovascular and cerebrovascular events at the 5-year follow-up [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Lesion durability found during mandated percutaneous catheter ablation after surgical cryo-ablation for treatment of non-paroxysmal atrial fibrillation

Bulava,

Mokráček,

Němec

et al. 2024

J Cardiothorac Surg

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Objectives Current recommendations support surgical treatment of atrial fibrillation (AF) in patients indicated for cardiac surgery. These procedures are referred to as concomitant and may be carried out using radiofrequency energy or cryo-ablation. This study aimed to assess the electrophysiological findings in patients undergoing concomitant cryo-ablation. Methods Patients with non-paroxysmal AF undergoing coronary artery bypass grafting and/or valve repair/replacement were included in the trial if concomitant cryo-ablation was part of the treatment plan according to current guidelines. The patients reported in this study were assigned to undergo staged percutaneous radiofrequency catheter ablation (PRFCA), i.e., hybrid treatment, as a part of the SURHYB trial protocol. Results We analyzed 103 patients who underwent PRFCA 105 ± 35 days after surgery. Left and right pulmonary veins (PVs) were found isolated in 65 (63.1%) and 63 (61.2%) patients, respectively. The LA posterior wall isolation and mitral isthmus conduction block were found in 38 (36.9%) and 18 (20.0%) patients, respectively. Electrical reconnections (gaps) in the left PVs were more often localized superiorly than inferiorly (57.9% vs. 26.3%, P = 0.005) and anteriorly than posteriorly (65.8% vs. 31.6%, P = 0.003). Gaps in the right PVs were more equally distributed anteroposteriorly but dominated in superior segments (72.5% vs. 40.0%, P = 0.003). There was a higher number of gaps on the roof line compared to the inferior line (131 (67.2%) vs. 67 (42.2%), P < 0.001). Compared to epicardial cryo-ablation, endocardial was more effective in creating PVs and LA posterior wall isolation (P < 0.05). Cryo-ablation using nitrous oxide (N20) or argon (Ar) gas as cooling agents was similarly effective (P = NS). Conclusions The effectiveness of surgical cryo-ablation in achieving transmural and durable lesions in the left atrium is surprisingly low. Gaps are located predominantly in the superior and anterior portions of the PVs and on the roof line. Endocardial cryo-ablation is more effective than epicardial ablation, irrespective of the cooling agent used.

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A Different View of Robotic Cryoablation of Atrial Fibrillation Combined With Mitral Valve Surgery

Kadan

Karabacak

Bolcal

2020

The Annals of Thoracic Surgery

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Randomized Trial of Concomitant Maze Procedure Using Nitrous Oxide- Versus Argon-Based Cryoablation

Cited by 7 publications

References 18 publications

Surgical options for atrial fibrillation treatment during concomitant cardiac procedures

Surgical options for atrial fibrillation treatment during concomitant cardiac procedures

Lesion durability found during mandated percutaneous catheter ablation after surgical cryo-ablation for treatment of non-paroxysmal atrial fibrillation

A Different View of Robotic Cryoablation of Atrial Fibrillation Combined With Mitral Valve Surgery

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