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J Am Coll Cardiol, 2002; 40:475-480 © 2002 by the American College of Cardiology Foundation |
* Department of Cardiology, Heart Center, University of Leipzig, Leipzig, Germany
Department of Heart Surgery, Heart Center, University of Leipzig, Leipzig, Germany
Manuscript received October 1, 2001; revised manuscript received January 23, 2002, accepted May 14, 2002.
* Reprint requests and correspondence: Dr. Hans Kottkamp, University of Leipzig, Heart Center, Cardiology, Department of Electrophysiology, Struempelstrasse 39, D04289 Leipzig, Germany.
Kotth{at}medizin.uni-leipzig.de
OBJECTIVES: A specific left atrial (LA) linear lesion concept for treatment of paroxysmal and permanent atrial fibrillation (AF) was tested using intraoperative ablation with minimally invasive surgical techniques.
BACKGROUND: Curative treatment for patients with chronic AF is among the main challenges of interventional electrophysiology.
METHODS: Seventy patients (mean age 53 ± 10 years) with drug-refractory persistent (n = 28) or paroxysmal (n = 42) AF underwent intraoperative radiofrequency (RF) ablation using video-assisted minimally invasive techniques via a right anterolateral minithoracotomy. Contiguous lesion lines involving the mitral annulus and the orifices of the pulmonary veins were placed with RF energy application under direct vision to prevent anatomically defined LA re-entrant circuits.
RESULTS: Mean follow-up was 18 ± 7 months in patients with permanent AF and 18 ± 5 months in patients with paroxysmal AF. Antiarrhythmic drug treatment was instituted in patients with postoperative atrial arrhythmias to allow "reverse electrical remodeling" and was discontinued after three months. Six months following ablation, 93% of the patients were in sinus rhythm in both groups, and after 12 months, 95% and 97%, respectively. As major complications, one esophagus perforation and one circumflex coronary artery stenosis were observed.
CONCLUSIONS: A pure linear lesion line concept confined to the left atrium targeting specifically at elimination of anatomically defined LA "anchor" re-entrant circuits eliminated AF in >90% of the patients treated with intraoperative ablation using minimally invasive surgical techniques over a mean follow-up of 1.5 years.
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