Minimally Invasive Surgery Using Bipolar Radiofrequency Energy Is Effective Treatment for Refractory Atrial Fibrillation

• Published in: The Annals of thoracic surgery Vol. 93; no. 5; pp. 1456 - 1461
• Main Authors: Kasirajan, Vigneshwar, MD, Spradlin, Elizabeth A., BS, Mormando, Tammy E, Medina, Angel E., RNAAS, Ovadia, Phillip, MD, Schwartzman, David S., MD, Gaines, Thomas E., MD, Mumtaz, Mubashir A., MD, Downing, Stephen W., MD, Ellenbogen, Kenneth A., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.05.2012; Elsevier
• Subjects: Age Distribution; Aged; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Atrial Fibrillation - diagnosis; Atrial Fibrillation - mortality; Atrial Fibrillation - surgery; Biological and medical sciences; Cardiac dysrhythmias; Cardiology. Vascular system; Cardiothoracic Surgery; Catheter Ablation - adverse effects; Catheter Ablation - methods; Cohort Studies; Electrocardiography - methods; Female; Heart; Hospital Mortality - trends; Humans; Incidence; Kaplan-Meier Estimate; Male; Medical sciences; Middle Aged; Minimally Invasive Surgical Procedures - methods; Minimally Invasive Surgical Procedures - mortality; Pneumology; Postoperative Complications - epidemiology; Postoperative Complications - physiopathology; Prognosis; Proportional Hazards Models; Recurrence; Registries; Retrospective Studies; Risk Assessment; Severity of Illness Index; Sex Distribution; Surgery; Survival Analysis; Thoracoscopy - methods; Thoracotomy - methods; Treatment Outcome; 24; Arrhythmia; Atrial fibrillation; Cardiovascular disease; Radiofrequency; Excitability disorder; Refractory; Bipolar; Minimally invasive surgery; Treatment; Energy; Heart disease; Anesthesia; Circulatory system; Cardiology
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2012.01.110

Background A web-based registry was used to prospectively study patients after minimally invasive surgery with monitoring to determine freedom from atrial fibrillation (AF) ( clinicaltrials.gov/ct2/show/NCT00747838 ). This is a report showing the utility and feasibility of the registry. Methods All patients had symptomatic AF refractory to medical treatment. Surgical ablation was performed using bipolar radiofrequency (RF) energy with a clamp around pulmonary veins and additional RF was delivered to ablate ganglionic plexi and create linear lesions. After a 3-month blanking period, prolonged electrocardiogram monitoring was done at 6 months, 1 year, and 2 years. Success was defined as no episodes of AF and atrial tachyarrhythmias greater than 30 seconds by monitoring. Results A total of 118 patients were studied from 4 institutions from June 2006 to February 2011. Seventy-two patients were male (61%). The mean age was 64 ± 9 years. CHADS 2 (Congestive heart failure, Hypertension, age greater than 75, Diabetes and Stroke score for risk of thromboembolic events in patients with atrial fibrillation) was 1.3. Warfarin was used in 92 (78%), antiarrhythmic medications in 108 (92%), and 35 (30%) had previous catheter ablation. Paroxysmal AF was present in 80 (68%), persistent AF present in 35 (30%), and long-standing persistent present in 3 (2%). The mean left atrial size was 4.4 cm. The surgical approach was bilateral minithoracotomy in 69 (58%) and totally thoracoscopic in 49 (42%). The left atrial appendage was excluded or excised in 112 (95%) patients. There were no deaths related to the procedure. Only 5 (4%) patients required ventilation greater than 24 hours; permanent pacemaker was needed in 3 (2%) patients. Mean length of hospital stay was 5 days. At a mean follow-up of 16.5 months, 80% of patients were free of AF off antiarrhythmic medications with long-term monitoring. Quality of life data showed significant improvement at 6 and 12 months. Conclusions The STAR (stable angina in practice) registry is an effective web-based tool for long-term follow-up of patients after surgery for AF. Minimally invasive surgery with lesions created by bipolar RF energy is an effective treatment for AF in carefully selected patients.