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Eur J Cardiothorac Surg 2005;28:80-82
© 2005 Elsevier Science NL

Editorial comment

Division of Cardiac Surgery, S. Raffaele University Hospital, Via Olgettina 60, 20132 Milan, Italy

^* Tel.: +39 0226 437 109; fax: +39 0226 437 125. (Email: stefano.benussi@hsr.it).

The first 20% of the full text of this article appears below.

Epicardial ablation have played a consistent role in refueling the popularity of atrial fibrillation (AF) surgery in recent years. The palpable perspective of a role of non-sternotomy, beating heart surgical ablation is increasingly stimulating surgeons, companies and some electrophysiologist.

In this context, transmurality of the presently available alternate physical means is one of the most compelling issues. The evidence provided by Bugge and colleagues [1], supporting the superiority of bipolar with respect to unipolar radiofrequency (RF) in epicardial ablation, is therefore timely and welcome.

Interestingly enough, the author's findings are coherent with recently reported clinical experience. Despite the reported good clinical results, there is no clear-cut evidence demonstrating that any presently available unipolar device can predictably yield an epicardial transmural scar. Epicardial microwave ablation on the beating heart at times fails to accomplish electrical isolation even after repeat ablation [2]. Scarce penetration of epicardial unipolar RF ablations was described by Santiago et al., depending upon composition and thickness of the atrial wall [3]. No such data is available for cryoenergy as . . . [Full Text of this Article]