Limited posterior left atrial cryoablation in patients with chronic atrialfibrillation undergoing valvular heart surgery

OBJECTIVES We sought to evaluate whether a limited surgical cryoablation of the posterior region of the left atrium was safe and effective in the cure of atrial fibrillation (AF) in patients with associated valvular heart dis ease. BACKGROUND Extensive surgical ablation of AF is a complex and risky procedu re. The posterior region of the left atrium seems to be important in the in itiation and maintenance of AF. METHODS In 32 patients with chronic AF who underwent heart valve surgery, l inear cryolesions connecting the four pulmonary veins and the posterior mit ral annulus were performed. Eighteen patients with AF who underwent valvula r surgery but refused cryoablation were considered as the control group. RESULTS Sinus rhythm (SR) was restored in 25 (78%) of 32 patients immediate ly after the operation. The cryoablation procedure required 20 +/- 4 min. T here were no intraoperative and perioperative complications. During the hos pital period, one patient died of septicemia. Thirty-one patients reached a minimum of nine months of follow-up. Two deaths occurred but were unrelate d to the procedure. Twenty (69%) of 29 patients remained in SR with cryoabl ation alone, and 26 (90%) of 29 patients with cryoablation, drugs and radio frequency ablation. Three (10%) of 29 patients remained in chronic AF. Righ t and left atrial contractility was evident in 24 (92%) of 26 patients in S R. In control group, two deaths occurred, and SR was present in only four ( 25%) of 16 patients. CONCLUSIONS Linear cryoablation with lesions connecting the four pulmonary veins and the mitral annulus is effective in restoration and maintenance of SR in patients with heart valve disease and chronic AF. Limited left atria l cryoablation may represent a valid alternative to the maze procedure, red ucing myocardial ischemic time and risk of bleeding. (C) 2000 by the Americ an College of Cardiology.