Objective: Epimyocardial Cryoablation (ECA) for surgical atrial ablation induces transmural
myocardial necrosis. After our initial series of 28 patients we increased the applied
time per lesion from 60 to 90s to test, if this leads to a higher incidence of sinusrhythm
(SR).
Methods: From 1/2003–08/2005 28 patients with chronic/paroxysmal atrial fibrillation (AF)
underwent ECA with concomittant cardiac surgery with 60s lesiontime (GroupI), 09/2005
until now 17 further patients received ECA with 90s lesiontime (Group II). Ablation
was performed during cardiac arrest. Postoperative regimes included amiodarone, metoprolol
and Phenprocoumon.
|
|
Group I
|
Group II
|
|
n
|
28
|
17
|
|
Age
|
64.7±7.6
|
71.1±8.3
|
|
Ejection fraction (%)
|
54±9.6
|
49±12
|
|
CABG
|
8
|
7
|
|
AVR
|
13
|
5
|
|
CABG + AVR
|
1
|
3
|
|
MVR + TVR/CABG
|
5
|
2
|
|
Ascending-aortic-replacement
|
1
|
0
|
Results: No intra-/perioperative ECA related complications. Average ablationtime 10±6min.
SR in Group I in 24%, 48%, 60% and 68% at discharge, 3, 6 and 12 month respectively,
in Group II in 35%, 64% and 70% at discharge, 3 and 6 month follow-up.
Conclusion: ECA is safe, without excessive prolongation of operative time and without the neccessity
to open the left-atrium. Extension of lesiontime seems to translate into a higher
quote of SR.
