A-Fib Ablation Shown Safe During Cardiac Surgery

When Dr. James L. Cox introduced the Cox-Maze III procedure for the surgical disruption of atrial fibrillation, the technique involved prolonged cutting and sewing, and the added time on cardiopulmonary bypass and cross-clamping this produced led to a lot of morbidity, including neurologic complications and renal failure.

The current study used a modified Maze procedure that primarily used cryoablation. Because no cutting and sewing were involved, the surgery was much easier, and it produced fewer complications. Surgeons are interested in an atrial fibrillation procedure that is safe and increases the likelihood of leading to sinus rhythm.

Mitchel L. Zoler/IMNG Medical Media Dr. Miguel Sousa Uva

This study is important because it shows that this method can be used safely and it improves the end point of resting sinus rhythm. It is paradoxical that the main rhythm benefit was in patients with long-standing persistent atrial fibrillation, because usually that is harder to treat. But this may have been a methodological issue, because they measured the 1-year rhythm outcome without doing prolonged, continuous ECG monitoring. It’s hard to define success in patients with paroxysmal atrial fibrillation unless you monitor patients continuously for a week.

The main message from this study was that the ablation procedure was safe during cardiac surgery and did not add much time or complexity to the surgery. I think these results will increase the use of ablation during cardiac surgery for other reasons. It is a major contribution.

Miguel Sousa Uva, M.D., a cardiac surgeon at Hospital da Cruz Vermelha in Lisbon, made these comments in an interview. He said that he had no disclosures.