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Jai Raman*, Siven Seevanayagam, Meg Storer, John Power#
*Dept. of Cardiac Surgery, Austin & Repatriation Medical Centre,
Heidleberg, Victoria, Australia
#Baker Institute of Medical Research, Prahran, Victoria, Australia
Introduction: The Maze procedure and its modifications
have had success in treating Atrial Fibrillation(AF), at the expense
of longer procedure times and increased morbidity. We evaluated
early results following application of radiofrequency ablation(RFA)
as a surgical adjunct in treating AF.
Methods: 20 patients with established or frequent intermittent
AF that were undergoing various cardiac surgical procedures were
enrolled. They had intra-operative creation of left and right
atrial RFA lesions in a pattern that included the salient features
of the Radial procedure and the bilateral isolation of pulmonary
veins(BIPV), with a hand held flexible probe (Cobra probe, EPT-Boston
Scientific Corp Inc, San Jose, CA). Patients were followed up
with echocardiography and Holter monitoring.
Results: Creation of lesions increased the cross clamp
time by a mean of 18 minutes. All 20 patients were weaned off
cardiopulmonary bypass in sinus rhythm. There were 2 early non-cardiac
deaths in high-risk patients. All surviving patients remained
in sinus rhythm at a mean folloe-up of 6 months. Three patients
were defibrillated into sinus rhythm 30, 40 & 60 days after
surgery. Test epicardial lesions on the right atrial appendage
in 10 patients showed full thickness coagulation of tissue.
Conclusions: A combined endocardial and epicardial set
of radiofrequency lesions in both atria using radial and BIPV
patterns abolished AF in most patients at 6 months and facilitated
easy conversion of recurrent AF into sinus rhythm. The transmural
nature of the epicardial lesions has implications for further
development.
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