Key result
Unipolar radiofrequency ablation was as effective as cryoablation (AF-free rate 82% vs 78%) and left atrial Maze was equipotent to bi-atrial Maze (76% vs 86%) at restoring sinus rhythm at discharge.
Why the study?
Does unipolar RF ablation or Lt-maze improve AF-free rates at discharge compared to cryoablation or Bi-maze in patients with AF undergoing cardiac surgery?
Cohort (n=100)
Does unipolar RF ablation or Lt-maze improve AF-free rates at discharge compared to cryoablation or Bi-maze in patients with AF undergoing cardiac surgery?
Unipolar RF ablation and Lt-maze are as effective as cryoablation and Bi-maze, respectively, for eliminating AF during concomitant cardiac surgery, though RF ablation has higher equipment costs.
Supports unipolar RF and left atrial Maze as alternatives in surgical AF ablation; leaves open randomized confirmation of outcomes.
This study evaluated the efficacy of the left atrial Maze procedure (Lt‐maze) and unipolar radiofrequency (RF) ablation as an additional procedure for the surgical treatment of atrial fibrillation (AF) in patient with other cardiac disease. Methods and Results: The Maze procedure was performed in 100 consecutive patients with AF: Lt‐maze, 71 patients; bi‐atrial Maze (Bi‐maze), 29 patients. Cryoablation and RF ablation were used in 82 and 18 patients, respectively. There were no in‐hospital or early deaths. Fourteen patients (14%) experienced postoperative complications. Seventy‐five patients (75%) were in sinus rhythm (SR) at discharge, 4 patients were in junctional rhythm, and 21 patients had AF. Two patients (2%) required permanent pacemaker implantation. The AF‐free rate at discharge was 79%, and the AF‐free rate at hospital discharge did not differ significantly between cryoablation and unipolar RF ablation (78% and 82%, respectively). There were no significant differences between these two groups in operative results, in terms of the aortic cross‐clamp time, cardiopulmonary bypass time, and AF‐free rate, with the AFfree rate not differing significantly in those who received single valve surgery (73% and 75% in the cryoablation and unipolar RF ablation groups, respectively). The equipment cost of the two procedures differed greatly: 14,000 yen/patient for cryoablation and 250,000 yen/patient for RF ablation. The AF‐free rate did not differ significantly between Lt‐maze (76%) and Bi‐maze (86%), including in those who received single valve surgery (72% and 79%, respectively). The significant predictors of AF recurrence in a univariate analysis were left atrial diameter (p = 0.03), duration of AF (p < 0.01), fibrillation amplitude on ECG (p = 0.02), and cardiothoracic ratio (p < 0.01), with the duration of preoperative AF being the only significant predictor of AF in a multivariate analysis. Conclusion: In this series, unipolar RF ablation for the Maze procedure was as effective as cryoablation at eliminating AF, and Lt‐maze and Bi‐maze were equipotent at restoring SR at discharge.
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Yoshikawa et al. (2006) conducted a cohort in Chronic Atrial Fibrillation with other cardiac disease (n=100). Unipolar radiofrequency ablation vs. Cryoablation was evaluated on AF-free rate at hospital discharge. Unipolar radiofrequency ablation was as effective as cryoablation (AF-free rate 82% vs 78%) and left atrial Maze was equipotent to bi-atrial Maze (76% vs 86%) at restoring sinus rhythm at discharge.
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