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European Journal of Cardio-Thoracic Surgery, Vol 12, 627-633, Copyright © 1997 by European Association for Cardio-thoracic Surgery
AM Patwardhan, HH Dave, AA Tamhane, SP Pandit, BV Dalvi, K Golam, A Kaul and AP Chaukar
OBJECTIVE: Radiofrequency catheter ablation of atrial tachycardias and
flutter is an established technique. The same modality in the microbipolar
mode is effective in producing full thickness coagulation injury. Cox's
maze procedure is highly successful in curing atrial fibrillation (AF)
surgically. However, it consumes relatively long cross clamp time and
cardiopulmonary bypass time. In this study, radiofrequency microbipolar
coagulation was used as an adjunct to corrective valve surgery, as an
intraoperative ablative modality to replace Cox's maze III incisions, thus
remarkably shortening the procedure. The results of this procedure are
compared historically with those of 26 patients who underwent corrective
valve surgery alone. METHODS: Radiofrequency microbipolar coagulation was
used to produce conduction blocks along the Cox's maze III incision lines
as an adjunct to valve surgery in 18 patients in atrial fibrillation
undergoing surgery for rheumatic valvular disease. A bayonet type bipolar
forceps with an active tip length of 7 mm drawing current from a
microbipolar port of Valleylab Force 4 electrosurgical unit (Valleylab,
Boulder, CO) was used for microbipolar coagulation. A 3-mm retinal handheld
cryoprobe working on nitrous oxide gas was used for cryoablation. RESULTS:
A total of 15 survivors in the coagulation maze group were followed from 43
to 224 days (149.7 +/- 73.1 mean +/- S.D.). Twelve of the 15 survivors
(80%) converted to normal sinus rhythm (70% confidence limit: 64.7-90.6%).
Atrial transport function studies with pulsed wave doppler, showed presence
of a wave in all the 12 (100%) patients in tricuspid valve flow and in nine
(75%) patients in mitral valve flow. The procedure took 11.62 +/- 3.86 min
of elective cardioplegic arrest time for the left atrial portion and 18.71
+/- 4.25 min of cardiopulmonary bypass time during reperfusion for the
right atrial portion. Of the 23 survivors out of 26 patients who underwent
the valve procedure alone, only one patient (4.3%) converted to normal
sinus rhythm (70% confidence limit: 0.6-14%). CONCLUSION: Thus, our
modification considerably shortened the time taken for creating the maze in
comparison to the Cox's maze procedure and was effective in restoring
normal sinus rhythm in 80% of the patients.
ARTICLES
Intraoperative radiofrequency microbipolar coagulation to replace incisions of maze III procedure for correcting atrial fibrillation in patients with rheumatic valvular disease
Department of Cardiovascular and Thoracic Surgery, LTMM College and LTMG Hospital, Sion, Mumbai, India.
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