Bipolar radiofrequency and cryoablation for surgical treatment of atrial fibrillation

Background: The widespread use of new sources of energy for ablation of atrial fibrillation (AF) raised concerns regarding the safety and efficacy of the various devices. This article describes the results of our technique using a combination of bipolar radiofrequency (RF) and cryoablation. Methods: From February 2004 till July 2006 this method was used on 94 patients. Fifty patients had persistent atrial fibrillation (53%), thirty-one suffered from permanent AF (33%) and thirteen patients had paroxysmal AF (14%). Lesions set similar to Maze III procedure were used with the addition of right atrial isthmus lesion in the area of coronary sinus and without right atrial appendage amputation and septal lesion. Results: There were no procedure-related complications and no death or major morbidity in general. Average time for ablation procedure was 30 minutes (range 27-36 minutes) for biatrial and 16 minutes (range 15-19) for left atrial procedures. Seventy-one patients (75%) were discharged in sinus rhythm. At the end of the follow-up, seventy-five patients (80%) were in sinus rhythm. Mean follow-up was 21 months (1-32 months). Predictor for recurrent AF or atrial flutter after procedure was preoperative permanent AF for more than 10 years (p=0.037) and cardiac surgery in the past (p=0.012). Conclusion: The use of bipolar RF device with cryoprobe is an appealing combination. It enables the completion of a Maze III lesion set in an easy, safe and efficient way.