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J Thorac Cardiovasc Surg 2003;126:1357-1365
© 2003 The American Association for Thoracic Surgery

Surgery for acquired cardiovascular disease

Surgical radiofrequency ablation of both atria for atrial fibrillation: results of a multicenter trial

^a Department of Cardiac Surgery, Austin and Repatriation Medical Centre, Heidelberg, Victoria, Australia
^b Baker Institute of Medical Research, Prahran, Victoria, Australia

Read at the Eighty-second Annual Meeting of The American Association for Thoracic Surgery, Washington, DC, May 5-8, 2002.

Received for publication April 22, 2002; revisions received July 8, 2002; revisions received September 24, 2002; accepted for publication November 18, 2002.

^* Address for reprints: Jai Raman, MBBS, MMed, FRACS, PhD, Section of Cardiac and Thoracic Surgery, University of Chicago Medical Center, 5841 S Maryland Ave, MC 5040, Chicago, IL 60637 United States
jraman{at}surgery.bsd.uchicago.edu

BACKGROUND: The Cox maze procedure has shown to be effective in treating atrial fibrillation. Radiofrequency ablation, with a similar objective, has been used as an adjunct to conventional cardiac surgery for the treatment of atrial fibrillation in more than 20 centers in Australia and New Zealand since March 2000. This is a report of those results.

METHODS: One hundred thirty-two patients in 20 centers underwent radiofrequency ablation as an adjunct to conventional cardiac surgery, with a standardized lesion set created with a flexible, 7-electrode, temperature-controlled probe (Cobra; EPTechnologies, San Jose, Calif). All data were entered into a central registry, with regular follow-up prompted by the registry cocoordinator. Each radiofrequency scar was made with standard parameters requiring 2 minutes of tissue coagulation at 80°C to 85°C. Patients undergoing mitral procedures had radiofrequency ablation performed in the left atrium endocardially. Patients undergoing aortic valve replacement or coronary artery bypass surgery underwent epicardial radiofrequency ablation of the left atrium. Epicardial radiofrequency ablation lesions on the right atrium were common to both groups of patients. Preoperatively, 75% of the patients had chronic atrial fibrillation, 21% had paroxysmal atrial fibrillation, and 4% had flutter. Surgical procedures performed included mitral valve procedure in 60%, coronary artery bypass grafting in 14%, aortic valve replacement in 7%, and coronary artery bypass grafting plus aortic valve replacement in 4%.

RESULTS: There were no major complications related to the use of radiofrequency ablation. There were no soft tissue or cardiac perforations. Ten patients were defibrillated into sinus rhythm within 3 months postoperatively. The freedom from atrial fibrillation was 84% at 3 months, 90% at 6 months, and 100% at 12 months. All patients at 12 and 18 months' follow-up were in sinus rhythm. There were no thromboembolic complications.

CONCLUSIONS: Surgical radiofrequency ablation can be performed safely as an adjunct to conventional cardiac surgery. A standardized lesion set created by using similar temperature settings can be adopted in multiple centers and might be effective in treating atrial fibrillation. Data collection through a central registry has helped in monitoring the effectiveness of this new technique in a scattered population.