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Eur J Cardiothorac Surg 2005;27:243-249
© 2005 Elsevier Science NL

Three years experience with monopolar and bipolar radiofrequency ablation surgery in patients with permanent atrial fibrillation

^a Department of Cardiac Surgery, AK St. Georg, Lohmuehlenstrasse 5, 20099 Hamburg, Germany
^b Department of Cardiology, AK St. Georg, Hamburg, Germany

Received 31 August 2004; received in revised form 15 October 2004; accepted 18 October 2004.

^* Corresponding author. Tel.: +49 40 2890 4150/4151; fax: +49 40 2890 4184. (E-mail: stephan.geidel{at}ak-stgeorg.lbk-hh.de).

Objective: In our population permanent atrial fibrillation (pAF) is a frequent concomitant problem in patients undergoing open heart surgery. A 3-year experience with a treatment strategy using mono- and bipolar radiofrequency (RF) ablation procedures in a heterogeneous group of patients is reported. Methods: In a prospective analysis the incidence of pAF among all patients undergoing open heart surgery in our department between February 2001 and July 2004 was evaluated. In a second step a selective group of 106 patients with pAF (primary mitral: n=63; aortic: n=24; CABG: n=16; aortic+mitral: n=3) underwent either monopolar (n=86) or bipolar (n=20) RF ablation procedures creating two encircling isolation lesions around the left and the right pulmonary veins (PVs) and a connection line between both. In addition amiodarone was given for 3 months after surgery. Regular follow-ups were performed 3, 6, 9, 12, 18, 24 and 36 months after surgery. Results: The incidence of pAF in the total group of 4.110 patients was 3.6%. While the rate was low in cases without severe heart valve disease (1.1%), a significantly higher presence of pAF in patients scheduled for heart valve surgery (10.3%) was observed (P<0.0001). The incidence was 30–39% in patients with degenerative and rheumatic mitral valve (MV) disease, and further particularly high in the older aged compared to younger patients (4.2–8.3% at 70–99 years; P<0.001). Hospital mortality after combined open heart and RF ablation surgery was 1.9%. Whereas patients with small left atrial size (LA-diameters <56mm; n=59) had SR in almost 90% at follow-up, LA enlargement (LA-diameter 56mm; n=47) was associated with a significant risk of persisting pAF after surgery (P=0.033, 0.002 and 0.006 at 3, 6 and 9 months follow-up). Conclusion: The use of RF ablation procedures in combination with amiodarone therapy represents a safe and efficient option to cure pAF during open heart surgery in a selective group of patients. The preoperative LA size was of significant importance for the outcome in this investigation.

Key Words: Atrial fibrillation • Atrial fibrillation surgery • Radiofrequency ablation • Arrhythmia surgery • Heart valve surgery • Bipolar radiofrequency ablation

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