Boston - American Association for Thoracic Surgery

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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
AMERICAN ASSOCIATION FOR THORACIC SURGERYCONCLUSION: Failures after HIFU were high and related to breakdown of thePV isolation line. Failures after Classic Maze were infrequent and isolated to themitral isthmus. Failures after concomitant surgery include right side breakthrough(primarily in pts with just LA lesion sets) and incomplete coronary sinus/mitralisthmus lesions. We now perform more extensive biatrial lesions, and wider cyroablationto the mitral valve annulus and coronary sinus. Identifying the location offailures may lead to higher future success and is being prospectively monitored.3:00 p.m. INTERMISSION – VISIT EXHIBITSExhibit HallMONDAYAfternoon85
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AATS FUTURE MEETINGSMay 1-5, 2010Me
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