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Ann Thorac Surg 2002;74:1050-1057
© 2002 The Society of Thoracic Surgeons

Original article: cardiovascular

Surgical ablation of atrial fibrillation using the epicardial radiofrequency approach: mid-term results and risk analysis

Stefano Benussi, MD, PhD*a, Simona Nascimbene, MDa, Eustachio Agricola, MDb, Giliola Calori, MDc, Simone Calvi, MDa, Alessandro Caldarola, MDa, Michele Oppizzi, MDb, Valter Casati, MDd, Carlo Pappone, MD, PhDe, Ottavio Alfieri, MDa

a Division of Cardiac Surgery, S Raffaele University Hospital, Milan, Italy
b Division of Cardiology, S Raffaele University Hospital, Milan, Italy
c Epidemiology Unit, S Raffaele University Hospital, Milan, Italy
d Division of Anesthesia, S Raffaele University Hospital, Milan, Italy
e Division of Arrhythmology, S Raffaele University Hospital, Milan, Italy

* Address reprint requests to Dr Benussi, Division of Cardiac Surgery, S Raffaele University Hospital, via Olgettina 60, 20132 Milan, Italy

Presented at the Thirty-eighth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–30, 2002.

Background. The minor technical and time requirements with respect to the maze operation combined with a comparable efficacy has led to an increasing popularity of left atrial approaches to treat atrial fibrillation. We report our experience with a left atrial procedure based on extensive use of epicardial radiofrequency ablation in an effort to minimize cardiac arrest time.

Methods. A total of 132 consecutive patients with atrial fibrillation (121 chronic, 11 paroxysmal) undergoing open heart surgery had combined intraoperative ablation. An original set of left atrial lesions was performed using a radiofrequency linear catheter. Most of the ablations were performed epicardially before aortic cross-clamping. Patients with contraindications to the epicardial approach had the whole lesion set performed endocardially.

Results. The mean cardiac arrest time spent for open heart ablations was significantly shorter (5.2 ± 0.9 minutes with modern catheters) when the epicardial approach was used (107 of 132 patients, 81%). Hospital mortality was 0.8%. Freedom from atrial fibrillation was 77% 3 years after the operation. Of all the variables analyzed, only age at surgery and early postoperative arrhythmias increased the risk of recurrent atrial fibrillation. Overall 3-year survival was 94%. The 3-year actuarial freedom from stroke was 98%. No patient required implantation of a permanent pacemaker. Atrial contractility was recovered in all patients with stable sinus rhythm.

Conclusions. Left atrial radiofrequency ablation allows recovery of sinus rhythm and atrial function in the great majority of patients with atrial fibrillation who undergo open heart surgery. The epicardial radiofrequency approach is a safe and effective means to cure atrial fibrillation with negligible technical and time requirements.




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