Subscribe to RSS
DOI: 10.1055/s-0029-1247087
Concomitant RF ablation surgery for permanent atrial fibrillation: influence of temperature controlled devices
Objective: Radio-frequency (RF) is a common energy source used in concomitant ablation for atrial fibrillation (AFib). Lesion transmurality with endocardial monopolar devices is considered crucial for procedural success. Different factors influencing early outcome and late recurrence of Afib have been recognized. We investigated the effect of different unipolar RF devices on postoperative restoration of sinusrhythm (SR).
Methods: Between 01.03.2007 and 01.03.2009, 94 consecutive patients (mean age 69.5±9.2, range 43 to 91 years) with permanent AFib underwent mitral (74%) and non-mitral concomitant monopolar RF ablation surgery. A standard left atrial lesion set was utilized. Saline irrigated RF was applied in 51 (Medtronic-Cardioblate®, groupA), and a temperature controlled device (ESTECH-Cobra®, groupB) in 43 patients. Mean preop LA diameter and preoperative EF was 52.4±5.9mm and 49.9±12.4%, respectively. Follow-up (97% complete) was obtained by a mail-questionnaire and 24-h Holter monitoring 27.6±23.8 months postoperatively.
Results: No ablation procedure related complication occurred. Overall 30-d mortality was 2.1%. There were 7 late deaths. At 2 years postop, SR and rhythm-control strategy was present in 40.7±0.08% (groupA) versus 61.2±0.1% (groupB) of patients (p=0.002). Results were comparable for mitral and non-mitral procedures. Correcting for the univariate factors associated with late recurrence of atrial fibrillation (age, left atrial diameter, duration of AFib and device used) in a multivariate model, only temperature-controlled RF device (p=0.004) was associated with superior late results (HR2.4).
Conclusion: Concomitant RF surgery was safe in all patients. Temperature controlled monopolar RF offers minimum lesion depth feedback and is associated with improved early and late results.