Epicardial Radiofrequency Ablation During Open Heart Surgery Stops Atrial Fibrillation
Surgeons have been able to abort atrial fibrillation by employing epicardial radiofrequency ablation techniques in patients with long-term atrial fibrillation undergoing open-heart surgery.
“After three years, 77 percent of these patients remain free of atrial fibrillation,” said Stefano Benussi, MD, of the Universita degli Studi, Milan, Italy, in his oral presentation at the 38th annual meeting of the Society of Thoracic Surgeons (STS). “The epicardial radiofrequency approach grants an effective and durable cure of atrial fibrillation.”
Patients in the study all had atrial fibrillation for an average of 3.5 years, Dr. Benussi reported. From February 1998 until September 2001, a total of 134 patients who were candidates for the procedure underwent open-heart surgery, most for replacement or repair of a mitral valve. The procedure involved a surgical radiofrequency pattern involving epicardial encircling of the pulmonary veins.
However, Dr. Benussi said, in 17 patients adhesions around the pulmonary blood vessels did not permit the use of radiofrequency to ablate the area of the rhythm disturbances. In five patients, doctors detected thrombi in the left atrium that they feared might cause further damage if the structures were disturbed. Three patients had implanted pacemaker wires that would have interfered with accurate ablation techniques.
The ablation procedures on the remaining 119 patients were uneventful, Dr. Benussi said. Overall, three patients in the study died within 30 days of the operations — one of pneumonia, one from stroke and one from a suspected myocardial infarction. He said it was not believed that the atrial fibrillation procedure contributed to those deaths.
Following radiofrequency ablation, there was no need to implant pacemakers in the patients to control the atrial fibrillation. “The procedure allows for a durable recovery of sinus rhythm. The procedure is simple and low-risk and is therefore suitable for combination with open heart operations,” Dr. Benussi said.
