CLINICAL STUDY: ATRIAL FIBRILLATION
Left atrial versus bi-atrial maze operation using intraoperatively cooled-tip radiofrequency ablation in patients undergoing open-heart surgery
Safety and efficacy
Thomas Deneke, MD*,*,
Krishna Khargi, MD ,
Peter Hubert Grewe, MD*,
Stefan von Dryander, MD*,
Frank Kuschkowitz, MD,
Thomas Lawo, MD*,
Klaus-Michael Müller, MD ,
Axel Laczkovics, MD and
Bernd Lemke, MD*
* Department of Cardiology/Angiology, Bochum, Germany
Clinic of Cardiothoracic Surgery, Bochum, Germany
Institute of Pathology, "Bergmannsheil," University Hospital, Bochum, Germany
Manuscript received June 18, 2001;
revised manuscript received February 21, 2002,
accepted February 25, 2002.
* Reprint requests and correspondence: Dr. Thomas Deneke, Department of Cardiology, Berufsgenossenschaftliche Kliniken Bergmannsheil, University of Bochum, Bürkle-de-la-Camp-Platz 1, 44789 Bochum, Germany.
thomas.deneke{at}ruhr-uni-bochum.de
OBJECTIVES: We sought to determine whether limited left atrial Maze surgery encircling each of the pulmonary veins, using cooled-tip radiofrequency (RF) ablation, is as effective as the bi-atrial approach?
BACKGROUND: The original Cox/Maze operation effectively restores sinus rhythm (SR) in patients with atrial fibrillation (AF). Ablation procedures aimed at eliminating pulmonary vein foci have produced promising short-term success.
METHODS: This was a prospective analysis of patients with chronic AF undergoing open-heart surgery in addition to the Maze operation, using intraoperatively cooled-tip RF ablation either in the left atrium alone (group A) or in both atria (group B).
RESULTS: Patients in group A (n = 21) and group B (n = 49) did not differ in terms of their baseline characteristics. Concomitant open-heart surgical procedures included mitral valve replacement (3 vs. 25), mitral valve plasty (0 vs. 2), mitral and aortic valve replacement (1 vs. 1), aortic valve replacement (4 vs. 6) and coronary artery bypass grafting (13 vs. 15) in groups A and B, respectively. Follow-up ranged from 1 to 50 months. The overall cumulative rates of SR were 82% in group A and 75% in group B, without a statistically significant difference (p = 0.571). Bi-atrial contraction was revealed in 92.3% of patients in SR in group A and in 79.2% in group B. The cumulative survival rates were 90.5% in group A and 77.9% in group B (p = 0.880).
CONCLUSIONS: A left or bi-atrial Maze operation using intraoperatively cooled-tip RF ablation can safely be combined with open-heart surgery. A left atrial Maze procedure seems to be as effective as the bi-atrial procedure and restores SR in 82% of patients.
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Abbreviations and Acronyms
| | AF | | atrial fibrillation | | RF | | radiofrequency | | SR | | sinus rhythm |
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