Background and early results of a modified left atrial radiofrequency procedure concomitant with cardiac surgery.

With the introduction of the maze operation Cox was able to show that the surgical treatment of atrial fibrillation (AF) is feasible. However, the maze operation remains surgically demanding and time-consuming as it requires multiple incisions in both atriums. This has led to the development of various modifications. With new ablative technology and the acceptable results of an exclusively left atrial maze procedure in combination with mitral valve surgery, it has become possible to simplify the maze operation radically. Thirty-one patients (mean age 62.3 years) with chronic or intermittent AF underwent a modified radiofrequency procedure in combination with some other cardiac surgical operation. Mitral valve disease coexisted in 17 patients, aortic valve disease in 9, coronary heart disease in 4 patients and 1 had an atrial septa! defect (ASD). After left atriotomy and with the use of the Thermaline radiofrequency ablator probe, bilateral pulmonary vein isolation was carried out. An additional ablation line was directed from the left pulmonary veins to the posterior mitral valve annulus, and finally the left atrial appendage was resected. The complete procedure added an average of only 18.2 minutes to the operation. In the early postoperative course AF or atrial flutter recurred in 12 patients but at discharge only 8 patients (24%) still had an arrhythmia. We concentrated on the first 26 patients of our series who had received a follow-up examination 3 months postoperatively. At discharge 18 of the 26 patients were in sinus rhythm (69.2%) and at 3 months after surgery 23 of 26 patients were in sinus rhythm (88.5%), with recovery of atrial contraction confirmed echocardiographically. Only 4 patients still required medication for arrhythmias. The modified radiofrequency ablation procedure of the left atrium proved to be simple to perform, quick and reliable. It offers the possibility of a surgical cure for AF when performed together with another cardiac operation, and the early results indicate a high rate of success for this simple procedure.