Combined endocardial and epicardial radiofrequency ablation of right and left atria in the treatment of atrial fibrillation

Background. The maze procedure and its modifications have been successful in treating atrial fibrillation (AF), at the expense of longer procedure times and increased morbidity. This study evaluated the early results of using radiofrequency ablation as a surgical adjunct in treating AF. Methods. Twenty-six patients, with established or frequent intermittent AF, who were undergoing various cardiac surgical procedures, were enrolled. During their operations, the patients underwent intraoperative left and right atrial radiofrequency ablation lesions using a handheld flexible probe. Patients were followed up with echocardiography and Holter monitoring. Results. All 26 patients were weaned off cardiopulmonary bypass in sinus rhythm. There were 2 early noncardiac deaths in high-risk patients; 23 surviving patients (95%) remained in sinus rhythm at a mean follow-up of 175 days (range 96 to 400 days). Three patients were defibrillated into sinus rhythm 30, 40, and 60 days after their operation. Test epicardial lesions on the right atrial appendage in 12 patients showed full-thickness coagulation of tissue in 10 (83%). Conclusions. A combined endocardial and epicardial set of radiofrequency lesions in both atria abolished AF in most patients at 6 months and facilitated easy conversion of recurrent AF into sinus rhythm. The transmural nature of the epicardial lesions has implications for further development.