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Eur J Cardiothorac Surg 2005;28:183-184
© 2005 Elsevier Science NL

Letter to the Editor

Reply to Shanmugam

Krishna Khargi a , * , Barbara A. Hutten b , Bernd Lemke c , Thomas Deneke d

a Department of Cardiothoracic Surgery, Haga (Leyenburg) Teaching Hospital, 2545 CH The Hague, The Netherlands
b Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
c Luedenscheid Hospital, Luedenscheid, Germany
d University Hospital Bergmannsheil Bochum, Bochum, Germany

Received 16 March 2005; accepted 18 March 2005.

* Corresponding author. Tel.: +31 70 3592000; fax: +31 70 3594014. (Email: k.khargi{at}hagaziekenhuis.nl).

Key Words: Atrial fibrillation • Electrophysiology • Arrhythmia • Maze • Radiofrequency • Microwave

Being complimented by the prestigious group from the Glasgow Royal Infirmary is a great honor. Thank you.

As requested we compared the sinus rhythm (SR) rates for the left and bi-atrial lesion patterns in the group of patients with atrial fibrillation who were treated with alternative sources of energy. A biatrial lesion pattern was conducted in 815 patients, whereas 1422 patients had a left atrial lesion pattern. The SR rates were 81.0 and 77.6%, respectively. Univariate analysis did not reveal any statistical significance (P=0.703) in the SR rates for the patients with left and bi-atrial lesion patterns, nor after correction for potential confounders such as age, type of arrhythmia and type of surgery (P values of 0.597, 0.327 and 0.499, respectively).

The necessity to create transmural lesions, visualized in the acute phase is still a matter of debate. There tends to be a discrepancy between the histological and electrophysiological characteristics during the acute phase after the creation of atrial lesions using radiofrequency or microwave ablation. Maessen and colleagues, who performed an epicardial beating-heart microwave ablation in 16 mongrel dogs, observed that histological analysis in the acute phase of the induced myocardial lesions were circumferentially incomplete (48±20%) in all dogs, although electrophysiological evaluation showed a complete entrance and exit block in 8 dogs and in another 5 dogs after repeated ablation. At follow-up (1–3 weeks), the isolations remained electrophysiologically complete. So, immediately after treatment, ablation lesions are best evaluated electrophysiologically, because complete (transmural and circumferential) lesions are not shown by histological evaluation in the acute stage [1]. This observation has been corroborated by Santiago and Pappone as discussed in our original manuscript. We do agree with the last two remarks of Dr Shanmugam, as discussed in the section limitations of the study of our manuscript [2].

References

  1. Brakel van TJ, Bolotin G, Salleng KJ, Nifong LW, Allessie MA, Chitwood Jr WR, Maessen JG. Evaluation of epicardial microwave ablation lesions: histology versus electrophysiology. Ann Thorac Surg 2004;78(4):1397-1402discussion 1397-402.[Abstract/Free Full Text]
  2. Khargi K, Hutten BA, Lemke B, Deneke T. Surgical treatment of atrial fibrillation; a systematic review. Eur J Cardiothorac Surg 2005;27(2):258-265.[Abstract/Free Full Text]




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