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J Am Coll Cardiol, 2000; 36:159-166
© 2000 by the American College of Cardiology Foundation
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CLINICAL STUDIES: ELECTROPHYSIOLOGY

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

Fiorenzo Gaita, MDa, Roberto Gallotti, MD*, Leonardo Calò, MDa, Eric Manasse, MD*, Riccardo Riccardi, MDa, Lucia Garberoglio, MDa, Francesco Nicolini, MD*, Marco Scaglione, MDa, Paolo Di Donna, MDa, Domenico Caponi, MDa and Giorgio Franciosi, MD*

a Division of Cardiology, Hospital of Asti, Asti, Italy; and
* Unit of Cardiac Surgery, Istituto Clinico Humanitas, Rozzano (Milano), Italy

Manuscript received July 29, 1999; revised manuscript received January 3, 2000, accepted March 1, 2000.

Reprint requests and correspondence: Dr. Fiorenzo Gaita, Division of Cardiology, Hospital of Asti, Via Botallo, 4, 14100 Asti, Italy
cardclin{at}provincia.asti.it

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 disease.

BACKGROUND

Extensive surgical ablation of AF is a complex and risky procedure. The posterior region of the left atrium seems to be important in the initiation and maintenance of AF.

METHODS

In 32 patients with chronic AF who underwent heart valve surgery, linear cryolesions connecting the four pulmonary veins and the posterior mitral annulus were performed. Eighteen patients with AF who underwent valvular surgery but refused cryoablation were considered as the control group.

RESULTS

Sinus rhythm (SR) was restored in 25 (78%) of 32 patients immediately after the operation. The cryoablation procedure required 20 ± 4 min. There were no intraoperative and perioperative complications. During the hospital period, one patient died of septicemia. Thirty-one patients reached a minimum of nine months of follow-up. Two deaths occurred but were unrelated to the procedure. Twenty (69%) of 29 patients remained in SR with cryoablation alone, and 26 (90%) of 29 patients with cryoablation, drugs and radiofrequency ablation. Three (10%) of 29 patients remained in chronic AF. Right and left atrial contractility was evident in 24 (92%) of 26 patients in SR. 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 atrial cryoablation may represent a valid alternative to the maze procedure, reducing myocardial ischemic time and risk of bleeding.

Abbreviations and Acronyms
  AF = atrial fibrillation
  ECG = electrocardiogram or electrocardiographic
  RF = radiofrequency
  SR = sinus rhythm




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