Atrial fibrillation ablation during mitral valve surgery using the Atricure™ device

Ralph J. Damiano, Sydney L. Gaynor L.

Research output: Contribution to journalReview article

24 Scopus citations

Abstract

We have now used bipolar radiofrequency ablation in over 50 cases. A total of 43 patients have undergone a complete modified Cox-Maze procedure as described above; 19 had a lone Maze procedure, and 24 had a Maze procedure plus a concomitant operation. At 1 month postoperatively, high resolution MRI scans were performed in the first 8 patients to evaluate for pulmonary vein stenosis. All patients have been followed monthly since their operation by clinical examination and serial electrocardiograms. In our early experience with this procedure, there have been no operative mortalities. The cross-clamp time required to perform the modified bipolar radiofrequency ablation-assisted Maze procedure was 43 ± 26 minutes. This was significantly shorter than our experience with the cut-and-sew lone Cox-Maze procedure (93 ± 34 minutes; P < 0.05). Similarly, for concomitant procedures, our cross-clamp time was reduced from 122 ± 37 minutes to 92 ± 37 minutes (P < 0.05) when compared with the traditional cut-and-sew Maze procedure. The mean follow-up time in our series has been 7.4 ± 5.5 months. Follow-up MRI showed no evidence of pulmonary vein stenosis, and atrial contractility was preserved in all patients. There were no late strokes. At a 6-months follow-up, 91% of patients were in sinus rhythm. At last follow-up, 41 of 43 patients (95%) were free from atrial fibrillation. At a 6-month follow-up, only 10 patients were still on antiarrhythmic drugs. Our results show that bipolar radiofrequency ablation can replace the majority of incisions of the traditional cut-and-sew Maze procedure. This significantly decreases the amount of time to perform the procedure. The morbidity with this new procedure appears to be low, while still maintaining the efficacy of the traditional cut-and-sew Maze procedure. With this simplified operation, the Maze procedure can safely be added to all patients with AF coming to the operating room for correction of their valvular heart disease.

Original languageEnglish
Pages (from-to)24-33
Number of pages10
JournalOperative Techniques in Thoracic and Cardiovascular Surgery
Volume9
Issue number1
DOIs
StatePublished - Jan 1 2004

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