International Society For Minimally Invasive Cardiothoracic Surgery

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Epicardial And Endocardial Use Of Cryoenergy And The Completeness Of Lesions During Surgical Ablation Of Atrial Fibrillation
Vojtech Kurfirst, Ales Mokracek, Júlia Csanády, Ladislav Pesl, Jiri Hanis, Alan Bulava.
Hospital of Ceske Budejovice, Ceske Budejovice, Czech Republic.

BACKGROUND: Cryoenergy, together with radio-frequency energy, is the most used method of lesion formation in patients undergoing surgical ablation of atrial fibrillation. Despite its frequent use, the clinical effect of cryoenergy use in endocardial and epicardial approach is unknown. The aim of this study was to compare the effect of different cryoenergy applications on the postoperative incidence of sinus rhythm and the completeness of the lesions performed.
METHODS: A total of 55 patients underwent surgical ablation of atrial fibrillation as part of another cardiac surgery procedure (myocardial revascularization, valve surgery, combined procedure). The standard protocol of surgical ablation contain isolation of the pulmonary veins and creation of box lesion by cryoenergy under various conditions - epicardially on extracorporeal circulation and cardiac arrest, epicardially on extracorporeal circulation on beating heart and endocardially. In the post-operative period, patients were invited to electrophysiological examination, where the completeness of surgical ablation lesions was evaluated and completed by catheter ablation if necessary.
RESULTS: 24 patients underwent epicardial ablation on the arrested heart (group 1), 12 patients underwent epicardial ablation on the beating heart (group 2) and 19 patients underwent endocardial ablation (group 3). The interval between cardiac surgery and electrophysiological examination was 144 ± 138 days vs. 178 ± 84 days vs. 102 ± 76 days. In the electrophysiological examination the sinus rhythm was presented in 71% vs. 83% vs. 89% of patients. The completeness of pulmonary vein isolation was confirmed in 31% vs. 25% vs. 95% of patients, complete box lesions then in 15% vs. 0% vs. 79% of patients.
CONCLUSIONS: Despite the similar clinical effect of surgical ablation in all three approaches, the morphologically most effective use of cryoenergy is endocardial ablation. This approach has a very good result. Our finding further supports the endocardial use of cryoenergy during surgical ablation of atrial fibrillation.

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