This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Leo A. Bockeria Amiran S. Revishvili Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Bockeria, L. A. Articles by Serguladze, S. Y. Search for Related Content PubMed Articles by Bockeria, L. A. Articles by Serguladze, S. Y. Related Collections Related Article

Irrigated monopolar radiofrequency ablation in surgical treatment atrial fibrillation

Bakoulev Scientific Center for Cardiovascular Surgery, Rublevskoe Shosse 135, Moscow 121552, Russia

Concomitant irrigated monopolar radiofrequency ablation of atrial fibrillation in adults with congenital heart disease

We congratulate Yong-Qiang Lai with co-authors on their interesting article dedicated to the surgical treatment of atrial fibrillation in adult patients with congenital heart diseases [1]. We would also like to share additional comments on this topic. In cardiac surgery, permanent or paroxysmal atrial fibrillation (AF) is exceptionally important because it is a common concomitant problem in patients scheduled for open heart surgery [2]. Atrial flutter and fibrillation occur in 14% to 22% of adult patients with unoperated atrial septal defect (ASD), and AF persists in a high percentage of patients after surgical closure of the defect unless a direct antiarrhythmic intervention is performed [3]. For adult patients with ASD and atrial arrhythmias, we also suggest adding irrigated radiofrequency ablation (IRF) to the surgical closure of the ASD. We agree with the conclusion of the authors that the irrigated monopolar IRF ablation system is easy to use, safe, and effective [4].

At our Center between September 2000 to November 2007, 180 combined operations for chronic AF and mitral valve disease (MV reconstruction or replacement), were performed including 92 radical operations for chronic AF: 35 patients (pts) underwent Maze-3 surgery, 40 – an irrigated RF modification of Maze-3 with monopolar IRF ablation (used Cardioblate Surgical Ablation System; Medtronic Inc, Minneapolis, MN) and 17- a cryo-modification of Maze-3 surgery. Mean age of patients was 45.7±12.6 years (range 27–167 years), AF duration was 3±2.3 years (6 months to 7 years). Average pre-operative LA dimension was 6.34±1.5 cm (4.5–8.4 cm). All patients were in NYHA class III–IV. From the 92 pts who underwent radical surgery for reversal of chronic AF, 1 pt (1.5%) died in hospital due to the spontaneous rupture of the LV posterior wall after RF modification of the Maze-3 surgery and LA plication. In general, by the time of discharge 82% of patients had sinus rhythm. None of our patients needed pacemaker implantation for postoperative AV block or sinus node dysfunction at the hospital discharge. Results of the different types of the Maze-3 operations were evaluated after 60±10.3 months by Santa Cruz scale [5] with scores ranging from 0 to 4. All patients with sinus rhythm (n=75. 81%) had the score 4, atrial contractile function of both atria was preserved in all of them up to five years after surgery. Four patients who had the score 3 required permanent pacemaker implantation at a long-term follow-up, as their atrial function was preserved. Our experience shows the reproducibility of different modifications of Maze-3 operation with the overall long-term efficiency over 80%.

In conclusion, we favor the strategy of performing both the left- and right-atrial ablation (Cox-Maze III) in AF patients with concomitant cardiac pathology.

	References

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1. Lai YQ, Li JH, Li JW, Xu SD, Luo Y, Zhang ZG. Concomitant irrigated monopolar radiofrequency ablation of atrial fibrillation in adults with congenital heart disease. Interact CardioVasc Thorac Surg 2008; 7:80–83.[Abstract/Free Full Text]
2. Brodell GK, Cosgrove D, Schiavone W, Underwood DA, Loop FD. Cardiac rhythm and conduction disturbances in patients undergoing mitral valve surgery. Cleve Clin J Med 1991; 58:397–399.[Medline]
3. Berger F, Vogel M, Kramer A, Alexi-Meskishvili V, Weng Y, Lange PE, Hetzer R. Incidence of atrial flutter/fibrillation in adults with atrial septal defect before and after surgery. Ann Thorac Surg July 1, 1999; 68:75–78.[Abstract/Free Full Text]
4. Giamberti A, Chessa M, Foresti S, Abella P, Butera G, Vincentiis C, Carminati M, Menicanti L, Frigiola A. Combined atrial septal defect surgical closure and irrigated radiofrequency ablation in adult patients. Ann Thorac Surg 2006; 82:1327–1331.[Abstract/Free Full Text]
5. Melo JQ, Neves J, Adragao P, Ribeiras R, Ferreira MM, Bruges L, Canada M, Ramos T. When and how to report results of surgery on atrial fibrillation. Eur J Cardiothorac Surg 1997; 12:739–745.[Abstract]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Leo A. Bockeria Amiran S. Revishvili Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Bockeria, L. A. Articles by Serguladze, S. Y. Search for Related Content PubMed Articles by Bockeria, L. A. Articles by Serguladze, S. Y. Related Collections Related Article