International Society For Minimally Invasive Cardiothoracic Surgery

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Comparison Of Irrigated And Non-irrigated Radiofrequency Ablation During The Cox-maze Iv Procedure: A Propensity Analysis
Ali J. Khiabani, Yun Zhu Bai, Robert M. MacGregor, Joshua L. Manghelli, Daniel I. Carter, Richard B. Schuessler, Spencer J. Melby, Ralph J. Damiano, Jr.
Washington University School of Medicine, St. Louis, MO, USA.

Objective: Various devices have been developed for surgical ablation of atrial fibrillation (AF) in order to simplify and replace the surgical incisions of the Cox-Maze procedure. One of the most common devices presently used is the bipolar radiofrequency (RF) clamps. However, the relative efficacy of bipolar irrigated RF compared to non-irrigated clamps has not been investigated. Methods: Between May 2003 and December 2017, 764 patients underwent a biatrial Cox-Maze IV procedure (CMP-IV) for refractory AF. Irrigated bipolar RF clamps were used in 156 patients (group A) while a non-irrigated bipolar RF clamps were used in the remaining 608 patients (group B). Patients in group A were propensity score matched to those in group B, using a logistic model with nearest neighbor 1:1 matching and a 0.1 caliper algorithm. Freedom from atrial tachyarrhythmias (ATAs) was determined by either electrocardiography, Holter, or pacemaker interrogation at 3, 6, and 12 months and yearly thereafter and was compared between the two groups. The majority of patients in both groups had prolonged monitoring. Results: One-hundred fifty-one patients were propensity matched in each group using 18 preoperative variables. There were no preoperative differences between the two groups including age (63.912.2 vs 62.511.3 years, p=0.318), BMI (31.07.5 vs 31.27.6, p=0.819), LA size (5.11.0 vs 5.11.1 cm, p=0.820), type (65% vs 62% with non-paroxysmal AF, p=0.720) and duration of AF (median [IQR]) (42 [12,93] vs 48 [11,84] months, p=0.643), and ejection fraction (54.311.1% vs 55.711.2%, p=0.294). In comparison to group B, more patients in group A underwent CMP-IV via sternotomy (91% vs 66%, p<0.001). There were no differences in operative mortality or postoperative complications between the two groups. Early and late freedom from atrial tachyarrhythmias (ATAs) on or off antiarrhythmic drugs (AADs) were similar between the two groups (Figure). Conclusions: The bipolar irrigated and non-irrigated radiofrequency clamps had similar complication rates and efficacy at restoring sinus rhythm at mid-term follow-up after a Cox-Maze IV procedure.
LEGEND: Figure. Freedom from atrial tachyarrhythmias (ATAs) in patients who underwent Cox-Maze IV procedure using irrigated bipolar radiofrequency clamp (Group A) compared to non-irrigated bipolar radiofrequency clamp (Group B).

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