A simple way to treat chronic atrial fibrillation during mitral valve surgery: the epicardial radiofrequency approach

Objective: We describe an original radiofrequency ablation technique to tre at chronic atrial fibrillation in patients undergoing mitral valve surgery. Most of the procedure is carried out epicardially, in order to avoid an un due increase of surgical time and trauma. Methods: The ablations are perfor med using a temperature-controlled multipolar radiofrequency catheter. Two encircling lesions around the ostia of the right and of the left pulmonary veins are carried out epicardially, usually before cardiopulmonary bypass. Through a conventional left atriotomy the ablation procedure is completed w ith two endocardial lesions connecting the two encirclings between them and to the mitral valve annulus. After the mitral valve procedure is performed , the left appendage is sutured. Results: From February 1998 to May 1999, 4 0 patients with chronic atrial fibrillation (43.1 +/- 51.9 months) underwen t combined radiofrequency ablation and mitral valve surgery. Mean left atri al diameter was 56.8 +/- 10.7 mm. Mean cardiopulmonary bypass and aortic cr oss-clamp time were, respectively, 119.1 +/- 26.3 and 76.7 +/- 21.0 min. Me an postoperative blood loss was 287.2 +/- 186.6 ml. No reexploration for bl eeding occurred. One patient died of pneumonia 12 days after operation. No patient needed permanent pacemaker implantation. Mean postoperative hospita l stay was 7.3 +/- 5.6 days. At follow-up (mean 11.6 +/- 4.7 months), 30/39 (76.9%) of the patients were in stable sinus rhythm. All patients in sinus rhythm 3 months after operation recovered both left and right atrial contr actility at echocardiographic control (mean 7.3 +/- 3.4 months). The left a trial diameter decreased significantly in patients recovering sinus rhythm. Conclusions: Epicardial radiofrequency ablation is a safe means to achieve surgical ablation of atrial fibrillation with a high success rate. The sim plicity of the technique and the low procedure-related risk should dictate combined treatment virtually in all patients with atrial fibrillation under going: open heart operations. (C) 2000 Elsevier Science B.V, All rights res erved.