Bipolar radiofrequency to ablate atrial fibrillation in patients undergoing mitral valve surgery

Abstract

Background: Atrial fibrillation (AF) affects 30% to 50% of patients undergoing mitral valve surgery. The optimum treatment of AF in these patients is unclear. The purpose of this study was to describe initial clinical experience using a bipolar radiofrequency clamp to facilitate AF ablation in patients undergoing mitral valve surgery.

Methods: From November 2001 through March 2003 a bipolar radiofrequency clamp was used to facilitate AF ablation in 108 patients undergoing mitral valve surgery. Preoperative AF was paroxysmal in 25%, persistent in 26%, and permanent in 49% of the patients. All patients underwent bilateral pulmonary vein isolation performed with the bipolar radiofrequency clamp and excision or exclusion of the left atrial appendage. Most patients had connecting lesions between the right and left pulmonary veins and between the left atrial appendage and the left pulmonary veins. Novel statistical methods were used to create a plot of the prevalence of AF versus time after surgery.

Results: Mean time required for AF ablation was 17+/-4 minutes (range, 9-28 minutes). All patients left the operating room with sinus rhythm or with atrial or atrioventricular pacing for an underlying nodal rhythm. Perioperative AF was common, affecting 64% of patients. At discharge, 33% of patients were in AF or atrial flutter. By 3 months postoperatively, the predicted prevalence of AF or atrial flutter was 15%. There were no device-related complications.

Conclusions: Bipolar radiofrequency facilitates rapid and safe AF ablation in patients with mitral valve disease. Perioperative AF is common and should be treated aggressively. By 3 months postoperatively, 85% of patients are free of AF or atrial flutter. Continued follow-up is necessary to document late results of this strategy.