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Specific linear left atrial lesions in atrial fibrillation

Intraoperative radiofrequency ablation using minimally invasive surgical techniques

Hans Kottkamp, MD^*,*, Gerhard Hindricks, MD^*, R.üdiger Autschbach, MD, Beate Krauss, MD^*, Bernhard Strasser, MD^*, Petra Schirdewahn, MD^*, Alexander Fabricius, MD, Gerhard Schuler, MD^* and Friedrich-Wilhelm Mohr, MD

^* Department of Cardiology, Heart Center, University of Leipzig, Leipzig, Germany
Department of Heart Surgery, Heart Center, University of Leipzig, Leipzig, Germany

View larger version (17K): [in a new window]   Figure 1 Schematic drawing of the left atrium and the geometry of the radiofrequency (RF) energy-induced left atrial (LA) linear lesion lines for treatment of atrial fibrillation (AF). The first lesion line extended from the inferior aspect of the mitral annulus (MA) to the left pulmonary veins (PVs). The second line connected the left lower pulmonary vein (LLPV) and left upper pulmonary vein (LUPV) orifices. From there, a third line coupled the left and right PVs. Then, the right upper pulmonary vein (RUPV) and right lower pulomary vein (RLPV) orifices were connected. Care was taken to advance the tip of the ablation probe only a few millimeters inside the proximal funnel-shaped parts of the PVs. Finally, the line at the LA roof was connected to the surgical incision to prevent "incisional reentry." This specific linear lesion line concept tested the hypothesis of targeting the perpetuation of chronic AF by elimination of anatomically defined "anchor" re-entrant circuits within the left atrium in contrast to functionally determined re-entrant circuits and in contrast to treating the initiating triggers of AF. The dotted line indicates the LA incision.

View larger version (20K): [in a new window]   Figure 2 Rhythm outcome after intraoperative ablation of paroxysmal atrial fibrillation (solid bars) and permanent (open bars) atrial fibrillation. AA = percentage of patients on antiarrhythmic drugs; SR = sinus rhythm.

View larger version (24K): [in a new window]   Figure 3 Echocardiographic data on left atrial (LA) diameter, E/A ratio at mitral valve and flow velocity within the left atrial appendage (LAA) following intraoperative ablation of atrial fibrillation. Open bars = permanent atrial fibrillation; Solid bars = paroxysmal atrial fibrillation.