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Early results of a novel versapolar temperature controlled radiofrequency device for epicardial, totally endoscopic surgical atrial fibrillation treatment in patients with persistent atrial fibrillation
Ralf Krakor1, Gianluigi Bisleri2, Pavol Kopriva1, Antonio Curnis2, Hanno Klemm3, Claudio Muretto2.
1Clinic for Cardiac Surgery at Klinikum Dortmund gGmbH, Dortmund, Germany, 2University of Brescia, Division of Cardiac Surgery,, Brescia, Italy, 3Clinic for Cardiology at Klinikum Dortmund gGmbH, Dortmund, Germany.

OBJECTIVE: Catheter ablation procedures have low effectiveness in isolated persistent and long standing (LS) persistent atrial fibrillation (AF). We analysed the preliminary results of epicardial, totally endoscopic ablation using a novel versapolar radiofrequency (RF) ablation device.
METHODS: In two heart centers between 5/2012 and 10/2013, 32 patients (pts) (persistent AF: 14 pts; LS persistent: 18 pts) underwent an endoscopic epicardial ablation procedure to create a box lesion set around all pulmonary veins with a radiofrequency device integrating both unipolar and bipolar ablation capabilities. If AF was detected at 3 months after the surgical ablation a catheter-based procedure was performed. At discharge (32 pts), 3 (30 pts), 6 (20 pts), 12 (14 pts), and 18 months (5 pts) after surgical ablation follow-up (fu) examinations including a quality of life (QoL) assessment were performed.
RESULTS: There were no intra and post-procedural complications or deaths. Postoperatively, at discharge, 3, 6, 12, and 18 months, freedom from AF was 96,6%, 96,6%, 90,0%, 100,0%, 100,0%, and 100,0% respectively. An additional catheter touch-up was required in only 2 patients. QoL assessments showed a significant post-procedure improvement of physical function, emotional well feeling, social functioning, and general health and a significant decrease in emotional problems and energy fatigue. At 1 year postoperatively, the use of warfarin was significantly decreased compared to the preoperative period (pre=81.3% vs 12 month fu=28.6%, p<0.001) as well as the use of Amiodarone compared to the 3 months follow up period (3 month fu=80% vs 12 month fu=21.4%, p<0.001). The left atrial antero-posterior diameter decreased significantly over 12 months postoperatively (pre=48.8±3.6mm vs 12 month fu=44.8±1.7mm, p<0.01).
CONCLUSIONS: The use of this novel versapolar ablation device was safe and effective in restoring and maintaining sinus rhythm in pts with persistent and LS persistent AF. The integration of unipolar and bipolar RF energy enabled an effective epicardial box lesion set to be delivered via a totally endoscopic approach.

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