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Ann Thorac Surg 2005;80:1417-1423
© 2005 The Society of Thoracic Surgeons

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Original article: Cardiovascular

En Bloc Exclusion of the Pulmonary Vein Region in the Pig Using Off Pump, Beating, Intra-Cardiac Surgery: A Pilot Study of Minimally Invasive Surgery for Atrial Fibrillation

^a Canadian Surgical Technologies and Advance Robotics, Lawson Health Research Institute, London, Ontario, Canada
^b Imaging Group, Robarts Research Institute, London, Ontario, Canada
^c Department of Physiology & Pharmacology, London, Ontario, Canada
^d Department of Medicine, London, Ontario, Canada
^e Department of Anaesthesia, London, Ontario, Canada
^f Department of Pathology, London, Ontario, Canada
^g Department of Medical Biophysics, University of Western Ontario, and London Health Science Center, London, Ontario, Canada

Accepted for publication March 3, 2005.

^_* Address reprint requests to Dr Guiraudon, Cardiac Surgery Department, CSTAR Building, LHSC-University Campus, 339 Windermere Road, London, Ontario N6A 5A5, Canada (Email: gguiraud{at}uwo.ca).

BACKGROUND: Off-pump, closed, beating heart, minimally-invasive surgery in patients with lone atrial fibrillation (AF) must be effective to become the preferred alternative to catheter ablation. Because of the inherent anatomical limitations of the epicardial access, we explored the feasibility of an intracardiac approach.

METHODS: We report an acute study of en bloc, cryo-exclusion of the pulmonary vein region in 7 pigs. The left atrial appendage (LAA) was approached via a left thoracotomy. Electrodes were attached to the posterior wall of the left atrium (LPA) and right atrial appendage (RAA) for pacing and electrophysiological monitoring. A modified Surgifrost probe was introduced via the LAA and positioned using transesophageal (TEE) and intracardiac (ICE) echocardiographic guidance to generate encircling cryolesions (3 minutes, –105°C) of the pulmonary vein region.

RESULTS: A complete two-way block was achieved in 6 pigs and an incomplete block in 1. The excluded segment had very slow idiosyncratic rhythm or was electrically silent. In all pigs before isolation, sustained AF was inducible with the most rapid rhythms and fractionated electrograms recorded from the LA. While sustained AF was induced before exclusion, it was not after isolation in either the exclude or non-excluded segments. All tissue samples taken along the encircling cryolesions had transmural cryolesions on pathological examination.

CONCLUSIONS: We conclude that off-pump, closed heart, beating, intracardiac AF surgery is feasible, reliable and can duplicate the accuracy and precision of the open-heart approach. However, further developments are needed to make this novel approach an alternative to current approaches for catheter ablation.

This article has been cited by other articles:

				D. G. Katritsis and A. J. Camm Catheter ablation of atrial fibrillation: do we know what we are doing? Europace, November 1, 2007; 9(11): 1002 - 1005. [Full Text] [PDF]

				G. M. Guiraudon, D. L. Jones, D. Bainbridge, and T. M. Peters Mitral valve implantation using off-pump closed beating intracardiac surgery: a feasibility study Interactive CardioVascular and Thoracic Surgery, October 1, 2007; 6(5): 603 - 607. [Abstract] [Full Text] [PDF]