Boston - American Association for Thoracic Surgery

89 TH ANNUAL MEETING MAY 9–MAY 13, 2009BOSTON, MASSACHUSETTS9. Where Does AF Surgery Fail?: Implications for Increasing AFSurgical Ablation EffectivenessPatrick M. McCarthy, * Jane Kruse, Shanaz Shalli, Leonard Ilkhanoff,Jeffrey Goldberger, Alan Kadish, Rishi Arora, Richard LeeDivision of Cardiothoracic Surgery, Northwestern University; NorthwesternMemorial Hospital, Chicago, IL, USAInvited Discussant: Chuen-Neng LeeOBJECTIVE: We sought to identify the location of failure of atrial fibrillation(AF) surgery to determine if a pattern exists that could be used to modify the procedureand increase effectiveness.METHODS: From April 2004 to September 2008, 386 pts (216 male; age 65.8 ±12.4; Table 1) underwent surgical ablation by a single surgeon primarily usingbipolar radiofrequency and cryoablation. This included 339 with other procedures(concomitant group), 47 lone AF [31 Classic; 16 High Intensity Focused Ultrasound(HIFU)]. Operative mortality was 1.8% for those with concomitant and 0%for lone AF surgery. Since January 2006 pts were prospectively followed, and allpreceding pts were retrospectively followed as well.Table 1Classic HIFU PVI LA only BiatrialMV Surgery ± other procedure 21 5 3 159 62AV Surgery ± other procedure 1 0 38 8 8Lone AF Surgery 31 16 0 0 0CABG 0 3 8 2 4Other combination 11 0 0 3 3RESULTS: At the our center 19 pts who developed AF or Atrial Flutter >3 monthsafter surgery underwent electrophysiology (EP) study with ablation. Of the ClassicMaze pts 3/64 were studied and found to have mitral annular flutter. Of the HIFUpatients 3/24 were studied (an additional 4 pts had ablation elsewhere) and all 7had breakdowns in the pulmonary vein isolation (PVI) lines. Need for ablationafter HIFU was much higher (7/24, 29%) than after Classic Maze (3/64, 4.7%, p =0.004). Of the concomitant group the location of arrhythmias was variable andincluded: RA flutter or RA tachycardia (8), left sided macroreentry around the PVor mitral annulus (7), PV (5), and focal mitral annular atrial tachycardia (1).* AATS Member84