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Eur J Cardiothorac Surg 2000;18:182-186
© 2000 Elsevier Science NL
a Santa Cruz Hospital, Carnaxide, Portugal
b Heart Institute, Carnaxide, Portugal
Received 7 September 1999; received in revised form 26 April 2000; accepted 10 May 2000.
Corresponding author. Instituto do Coração, Av. Prof Reinaldo Santos 27, 2795 Carnaxide, Portugal. Tel.: +351-14-165-900; fax: +351-14-195-918
e-mail: jqmelo{at}hsc.min-saude.pt
Objective: Atrial fibrillation has been a difficult problem to solve in many surgical patients, especially in those with mitral valve pathology. This study evaluates the results of endocardial and epicardial radiofrequency ablation with a new intra-operative device in the treatment of atrial fibrillation. Methods: We operated on 65 patients with atrial fibrillation, 58 of which had concomitant mitral surgery. Atrial fibrillation was chronic (over 1 year) in 46 patients (group A) and paroxysmal or recent onset in 12 (group B). Group C had lone atrial fibrillation (two), concomitant coronary artery disease (four) or a sarcoma (one). Bilateral pulmonary vein isolation with a new intra-operative device was performed through multiple dry lesions in all patients. Groups A and B had endocardial applications at 70°C during 60 s and group C had epicardial applications at 75°C. Three group C patients had epicardial applications off pump. Atrial wall biopsies were performed in nine patients from groups A and B. Results: There were no serious post-operative complications. At 1 month follow-up 54% of all patients were out of atrial fibrillation and 34% were in normal sinus rhythm with bilateral atrial contraction (Santa Crus Score 4). At 6 months follow-up, in spite of some crossover of patients among groups, similar results were obtained. The success of the procedure was 69% (Santa Crus scores 3 and 4) in mitral patients with a left atrial volume smaller than 200 cm3. Preliminary data on the transmurality of the lesions is presented. The patients submitted to epicardial radiofrequency ablation (group C) have satisfactory results at 1 month (six out of seven were out of AF). Conclusions: Both endocardial and epicardial RF applications are simple and quick to perform and do not pose an additional risk for most patients. Furthermore we believe that it is possible to perform bilateral epicardial radiofrequency ablation of the pulmonary veins without cardiopulmonary bypass. Further refinements of the technique are needed to assure transmurality of all lesions and better results.
Key Words: Atrial fibrillation surgery • Radiofrequency catheter ablation • Pulmonary vein isolation • Arrhythmia surgery • Mitral valve surgery
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