Recent topics on the surgical treatment of chronic atrial fibrillation: Efficacy and safety of Cryosurgical ablation

Background: Although the classical Cox-Maze III is the gold standard surgical therapy with a proved efficacy in atrial fibrillation (AF) therapy, complexity of this procedure dictated a more simple, less invasive cost-effective method. In an attempt to achievement of this purposes we evaluated the role of cryosurgical ablation. Patients Method: Ninety patients (mean age: 50.9+/-12 yr.) with open heart surgeries complicated by chronic AF, underwent cryoablation with a new designed N2O-based cryotherapy device (Danesh Co. Ltd) during the main heart operations. Pulmonary vein isolation with or without left atrial appendage closure (Group A) carried in 65cases Biatrial Cox-Maze III (Group B) for the others .This additional procedure consuming only about 10 min for P.V isolation group about 20 min. for Cox-Maze III group. Half of the patient received a beta-blocker after AF ablation. Results: The overall success rate of cryoablation was 65.5%. Normal sinus rhythm achieved in 26.7% at operating room, 10% at ICU remaining cases got the sinus rhythm during follow up period. There were no ablation-related serious post-operation complication such as bleeding, thromboembolic events A-V block. The only predictor for failure of ablative procedure was sever left atrial enlargement ( 6 cm).Conclusion: Although the efficacy rate of cryoablative surgery was not as high as classic Cox-Maze III at present study, it seems that the supplementation of this safe, simple, cost-effective not time consuming procedure may enhances the cure rate of chronic AF during mitral valve surgeries.