Document Detail

Surgical ablation of atrial fibrillation using the epicardial radiofrequency approach: mid-term results and risk analysis.
MedLine Citation:
PMID:  12400744     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: The minor technical and time requirements with respect to the maze operation combined with a comparable efficacy has led to an increasing popularity of left atrial approaches to treat atrial fibrillation. We report our experience with a left atrial procedure based on extensive use of epicardial radiofrequency ablation in an effort to minimize cardiac arrest time. METHODS: A total of 132 consecutive patients with atrial fibrillation (121 chronic, 11 paroxysmal) undergoing open heart surgery had combined intraoperative ablation. An original set of left atrial lesions was performed using a radiofrequency linear catheter. Most of the ablations were performed epicardially before aortic cross-damping. Patients with contraindications to the epicardial approach had the whole lesion set performed endocardially. RESULTS: The mean cardiac arrest time spent for open heart ablations was significantly shorter (5.2 +/- 0.9 minutes with modem catheters) when the epicardial approach was used (107 of 132 patients, 81%). Hospital mortality was 0.8%. Freedom from atrial fibrillation was 77% 3 years after the operation. Of all the variables analyzed, only age at surgery and early postoperative arrhythmias increased the risk of recurrent atrial fibrillation. Overall 3-year survival was 94%. The 3-year actuarial freedom from stroke was 98%. No patient required implantation of a permanent pacemaker. Atrial contractility was recovered in all patients with stable sinus rhythm. CONCLUSIONS: Left atrial radiofrequency ablation allows recovery of sinus rhythm and atrial function in the great majority of patients with atrial fibrillation who undergo open heart surgery. The epicardial radiofrequency approach is a safe and effective means to cure atrial fibrillation with negligible technical and time requirements.
Stefano Benussi; Simona Nascimbene; Eustachio Agricola; Giliola Calori; Simone Calvi; Alessandro Caldarola; Michele Oppizzi; Valter Casati; Carlo Pappone; Ottavio Alfieri
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  74     ISSN:  0003-4975     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2002 Oct 
Date Detail:
Created Date:  2002-10-28     Completed Date:  2002-11-26     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1050-6; discussion 1057     Citation Subset:  AIM; IM    
Division of Cardiac Surgery, S Raffaele University Hospital, Milan, Italy.
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MeSH Terms
Atrial Fibrillation / mortality,  physiopathology,  surgery*
Catheter Ablation / methods*
Chronic Disease
Middle Aged
Pericardium / surgery
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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