Objectives: To evaluate two devices used in concomitant AF patients.
Methods: From January until December 2008, all patients in concomitant AF(n=42) underwent ablation for either persistent/permanent(66%) or paroxysmal AF(33%). Patients undergoing mitral valve surgery(n=30,29 repairs) received a full Cox Maze IV using an unipolar radiofrequency device (Cardioblate,Medtronic), an exclusion of their left atrial appendage(LAA) and a reduction of the size of the left atrium(LA). Patients with CABG or aortic valve surgery(n=12) received a box lesion and epicardial left isthmus line across the coronary sinus, using a HIFU device (Epicor,St.JudeMedical). A systematic 6 month postoperative control included physical examination, ECG and 48h-Holter monitoring.
b In the Epicor group, 80% was asymptomatic and in sinus rhythm(SR). However, Holtermonitoring revealed 50% permanent SR, all of them in the paroxysmal group. There were no pacemaker implants, but 20% developed LA flutter. In the Cardioblate group, 89% was asymptomatic and had no AF. However, Holtermonitoring revealed only 44% permanent SR. LA size was adequately reduced (mean 4,4±0,7cm). Three patients required a pacemaker.
Conclusions: A 48h-Holtermonitoring is mandatory for evaluating effectiveness of ablation; symptoms and classical ECG are unreliable. Epicor was only effective in paroxysmal patients, and caused, despite the left isthmus line, a 20% incidence of symptomatic LA flutter. True SR recovery, 6 months after mitral surgery, was lower than that reported with bipolar devices, but most patients had long standing AF and all had dilated atria. In paroxysmal and in selected patients with persistent AF, we shall still use Epicor but go over to bipolar devices after mitral surgery. In chronic AF with dilated LA (≥55mm), we shall only reduce LA dimensions and exclude LAA.