Surgical ablation of atrial fibrillation with off-pump, epicardial, high-intensity focused ultrasound: Results of a multicenter trial

Jean Ninet, Xavier Roques, Rainald Seitelberger, Claude Deville, Jose Luis Pomar, Jacques Robin, Olivier Jegaden, Francis Wellens, Ernst Wolner, Catherine Vedrinne, Roman Gottardi, Javier Orrit, Marc Alain Billes, Drew A. Hoffmann, James L. Cox, Gerard L. Champsaur

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Abstract

Background: A simplified alternative to the Cox maze procedure to treat atrial fibrillation with epicardial high-intensity focused ultrasound was evaluated clinically, and the initial clinical results were assessed at the 6-month follow-up visit. Methods: From September 2002 through February 2004, 103 patients were prospectively enrolled in a multicenter study. Atrial fibrillation duration ranged from 6 to 240 months (mean, 44 months) and was permanent in 76 (74%) patients, paroxysmal in 22 (21%) patients, and persistent in 5 (5%) patients. All patients had concomitant operations, and ablation was performed epicardially on the beating heart before the concomitant procedure. The device automatically created a circumferential left atrial ablation around the pulmonary veins in an average of 10 minutes, and an additional mitral line was created epicardially in 35 (34%) patients with a handheld device by using the same technology. Results: No complications or deaths were device or procedure related. There were 4 (3.8%) early deaths and 2 late extracardiac deaths. The 6-month follow-up was complete in all survivors. At the 6-month visit, freedom from atrial fibrillation was 85% in the entire study group (80% in patients with permanent atrial fibrillation, 88% in the 35 patients who had the additional mitral line, and 100% in patients with paroxysmal atrial fibrillation). A pacemaker was implanted in 8 patients. Only the duration and type of atrial fibrillation significantly increased the risk of recurrence. Conclusion: Epicardial, off-pump, beating-heart ablation with acoustic energy is safe and cures 80% of patients with permanent atrial fibrillation associated with long-standing structural heart disease.

Original languageEnglish
Pages (from-to)803.e1-803.e8
JournalJournal of Thoracic and Cardiovascular Surgery
Volume130
Issue number3
DOIs
StatePublished - Sep 2005

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    Ninet, J., Roques, X., Seitelberger, R., Deville, C., Pomar, J. L., Robin, J., Jegaden, O., Wellens, F., Wolner, E., Vedrinne, C., Gottardi, R., Orrit, J., Billes, M. A., Hoffmann, D. A., Cox, J. L., & Champsaur, G. L. (2005). Surgical ablation of atrial fibrillation with off-pump, epicardial, high-intensity focused ultrasound: Results of a multicenter trial. Journal of Thoracic and Cardiovascular Surgery, 130(3), 803.e1-803.e8. https://doi.org/10.1016/j.jtcvs.2005.05.014