International Society For Minimally Invasive Cardiothoracic Surgery

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Which Energy Source Is Superior? Bipolar Radiofrequency Vs. Cryoablation In Concomitant Af Surgery
Johannes Petersen, Samer Hakmi, Yousuf Alassar, Florian Mathias Wagner, Hermann Reichenspurner, Simon Pecha.
University Heart Center Hamburg, Hamburg, Germany.

Introduction:
Concomitant surgical ablation is an established procedure for patients with atrial fibrillation (AF) undergoing cardiac surgery. Different energy sources are available to perform surgical ablation. At the moment, there is no clear evidence which energy source is superior. We therefore compared bipolar radiofrequency (RF) with cryoablation in concomitant AF surgery.
Methods:
Between 2003 and 2013 556 patients underwent concomitant surgical AF ablation in our institution. 116 patients were treated with cryoablation (Cryo-group) and 164 patients were ablated with bipolar RF (RF-group) and were included in this retrospective data analysis. Rhythm monitoring by either 24h-Holter ECG (Cryo-group: 90 patients; RF-group: 86 patients) or Implantable loop recorder (ILR) (Cryo-group: 26 patients; RF-group: 78 patients). Logistic regression analysis was used to identify predictors for rhythm outcome. Primary endpoint of the study was freedom from AF at 12 months follow-up.
Results:Mean age was similar in both groups (Cryo-group: 68.9 7.9 vs. RF-group: 70.3 8.6; p = 0.194) and both groups consisted of predominantly male patients (Cryo-group: 77.5 % vs. RF-group: 71.3 %; p = 0.270). Paroxysmal AF was present in 50.4 % of the Cryo-group and 39.9 % of the RF-group; p = 0.086. There were no major ablation related complications and no intraoperative death. Survival at 12 months was 97.9 and 95.6 % in both groups; p = 0.299. Freedom from AF did not differ significantly between cryoablation and RF at 3 (Cryo-group: 52.3 % vs. RF-group: 61.9 %; p = 0.124) and 6 months (Cryo-group: 66.7 %; RF-group: 71.1 %; p = 0.497). At 12 months, freedom of AF was significantly higher in the RF-group (78.7 %) compared to the Cryo-group (63.4 %); p = 0.006. During 12 months follow-up cardioversion (RF-group: 9.5 % vs. cryo-group: 5.3 %; p = 0.215) and catheter-based ablation (RF-group: 3.6 % vs. cryo-group: 2.6 %; p = 0.648) was performed similar often in both groups. Multivariate logistic regression analysis for freedom of AF at 12 months showed simultaneous double valve procedures (OR 0.045; p = 0.019) and longer duration of AF (OR 0.835; p = 0.042) as negative predictors in the Cryo-group and paroxysmal AF (OR 2.701; p = 0.037) as positive predictor in the RF-group.
Conclusion:
In our studied cohort, bipolar radiofrequency was more effective to restore SR at 12 months compared to cryoablation. Predictors for freedom from AF are shorter duration of AF (cryoablation) and paroxysmal AF (RF).


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