Epicardial Beating Heart “Off-Pump” Ablation of Atrial Fibrillation in Non-Mitral Valve Patients Using New Irrigated Bipolar Radiofrequency Technology

Purpose We evaluated the use of a novel irrigated bipolar radiofrequency system for the treatment of nonmitral paroxysmal atrial fibrillation. Description Between December 2003 and July 2005, 24 patients with paroxysmal atrial fibrillation underwent nonmitral cardiac procedures (coronary artery bypass grafting, n = 14; aortic valve replacement, n = 6; aortic valve replacement and coronary artery bypass grafting, n = 3; Bentall procedure, n = 1). In 12 of 14 of the coronary artery bypass graft patients, the procedure was performed off pump. All patients additionally underwent pulmonary vein isolation using the Medtronic Cardioblate BP system (Medtronic, Minneapolis, MN). Acute conduction block was evaluated in 16 patients. Evaluation Patients were followed-up for 6 months. Major adverse events include 1 patient death and 1 patient requiring implantation of a pacemaker. At discharge 19 of 22 patients (86.3%) were in stable sinus rhythm. After 3 months, stable sinus rhythm was found in 15 of 21 patients (71%). After 6 months, 15 of 15 patients (100%) were in stable sinus rhythm. Complete conduction block was accomplished in 29 of 32 pulmonary vein pairs (91%) after a single radiofrequency ablation and in 31 of 32 pairs (97%) after a second application. Conclusions Pulmonary vein isolation with the use of this irrigated bipolar radiofrequency device is feasible, safe, and gains high experimental and clinical efficacy, including use during off-pump surgery.