Retrospective investigation of postoperative mid-term results of cryoablation and radiofrequency ablation methods used in atrial fibrillation surgery treatment

Year 2021, Volume: 7 Issue: 5, 501 - 508, 04.09.2021

Ahmet Burak Tatlı Arda Aybars Pala Mesut Engin Temmuz Taner Yusuf Ata

https://doi.org/10.18621/eurj.814878

Cited By: 2

Abstract

Objectives: Atrial fibrillation (AF) is the most common arrhythmia encountered and is usually seen in patients scheduled for coronary artery bypass and mitral valve surgery. Radiofrequency ablation and cryoablation are two methods used in AF surgery and proven efficacy. In this study, cryoablation and radiofrequency ablation methods were compared in terms of clinical outcomes, efficacy and safety.

Methods: Between November 2011 and September 2017; 99 patients with AF who underwent radiofrequency ablation or cryoablation during open heart surgery were included in this study with 2 groups. The patients who underwent cryoablation were defined as Group I (n = 40), and the patients who underwent radiofrequency ablation as Group II (n = 59). Preoperative, perioperative, early and mid (1 year) postoperative period characteristics of the groups were analyzed.

Results: The mean age was 60.6 ± 9 years in Group I and 60.7 ± 9.1 years in Group II (p = 0.960). When the operative values were examined, ablation time and cross-clamp time was found to be low in Group II and a statistically significant difference was found (p < 0.001 and p = 0.043; respectively). When the rhythms of the postoperative first year controls are examined, sinus rhythm was observed in 34 (85%) patients in Group I and 50 (84.7%) patients in Group II. There was no statistically significant difference in return to sinus rhythm in the first year (p = 0.975).

Conclusions: The success rates of these two methods used in AF surgery are effective but they are not superior to each other.

Keywords

Atrial fibrrilation, cryoablation, radiofrequency ablation, surgical ablation

References

• 1. Hunter RJ, Baker V, Finlay MC, Duncan ER, Lovell MJ, Tayebjee MH, et al. Point-by-point radiofrequency ablation versus the cryoballoon or a novel combined approach: a randomized trial comparing 3 methods of pulmonary vein isolation for paroxysmal atrial fibrillation (The Cryo versus RF Trial). J Cardiovasc Electrophysiol 2015;26:1307-14.
• 2. Erdolu B, As AK. The relationship between postoperative atrial fibrillation after coronary artery bypass surgery and serum heat shock protein levels and inflammation. Eur Res J 2020;6:409-15.
• 3. Pala AA, Urcun YS. Is the mean platelet volume a predictive factor for atrial fibrillation developing after coronary artery bypass grafting in elderly patients? Heart Surg Forum 2020;23:E809-14.
• 4. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur J Cardiothorac Surg 2016;50:e1-e88.
• 5. Melby SJ, Schuessler RB, Damiano RJ Jr. Ablation technology for the surgical treatment of atrial fibrillation. ASAIO J 2013;59:461-8.
• 6. Barnett SD, Ad N. Surgical ablation as treatment for the elimination of atrial fibrillation: a meta-analysis. J Thorac Cardiovasc Surg 2006;131:1029-35.
• 7. Chavez EK, Colafranceschi AS, Monteiro AJO, Canale LS, Mesquita ET, Weksler C, et al. Surgical treatment of atrial fibrillation in patients with rheumatic valve disease. Braz J Cardiovasc Surg 2017;32:202-209.
• 8. McCarthy PM, Manjunath A, Kruse J, Andrei AC, Li Z, McGee EC Jr, et al. Should paroxysmal atrial fibrillation be treated during cardiac surgery? J Thorac Cardiovasc Surg 2013;146:810-23.
• 9. Güvenç O, Göncü MT, Engin M, Çayır MÇ, Özyazıcıoğlu AF. Effects of coronary endarterectomy on postoperative early results in long segment coronary artery disease. Eur Res J 2020;6:187-92.
• 10. Öztürk C, Yavuz Ş. Effect of coronary artery bypass surgery on ventricular functions in patients with poor left ventricular function. Eur Res J 2019;5:502-9.
• 11. Yang S, Mei B, Feng K, Lin W, Chen G, Liang M, et al. Long-Term Results of Surgical Atrial Fibrillation Radiofrequency Ablation: Comparison of Two Methods. Heart Lung Circ 2018;27:621-8.
• 12. Jessurun ER, van Hemel NM, Kelder JC, Elbers S, de la Rivière AB, Defauw JJ, et al. Mitral valve surgery and atrial fibrillation: is atrial fibrillation surgery also needed? Eur J Cardiothorac Surg 2000;17:530-7.
• 13. Forlani S, De Paulis R, Guerrieri Wolf L, Greco R, Polisca P, Moscarelli M, et al. Conversion to sinus rhythm by ablation improves quality of life in patients submitted to mitral valve surgery. Ann Thorac Surg 2006;81:863-7.
• 14. Mugnai G, Chierchia GB, de Asmundis C, Sieira-Moret J, Conte G, Capulzini L, et al. Comparison of pulmonary vein isolation using cryoballoon versus conventional radiofrequency for paroxysmal atrial fibrillation. Am J Cardiol 2014;113:1509-13.
• 15. Doll N, Borger MA, Fabricius A, Stephan S, Gummert J, Mohr FW, et al. Esophageal perforation during left atrial radiofrequency ablation: Is the risk too high? J Thorac Cardiovasc Surg 2003;125:836-42.
• 16. Gillinov AM, Pettersson G, Rice TW. Esophageal injury during radiofrequency ablation for atrial fibrillation. J Thorac Cardiovasc Surg 2001;122:1239-40.
• 17. Sueda T, Shikata H, Mitsui N, Nagata H, Matsuura Y. Myocardial infarction after a maze procedure for idiopathic atrial fibrillation. J Thorac Cardiovasc Surg 1996;112:549-50.
• 18. Benussi S, Nascimbene S, Calvi S, Alfieri O. A tailored anatomical approach to prevent complications during left atrial ablation. Ann Thorac Surg 2003;75:1979-81.
• 19. Güden M, Akpinar B, Sanisoğlu I, Sağbaş E, Bayindir O. Intraoperative saline-irrigated radiofrequency modified Maze procedure for atrial fibrillation. Ann Thorac Surg 2002;74:S1301-6.
• 20. Ramlawi B, Abu Saleh WK, Edgerton J. The left atrial appendage: target for stroke reduction in atrial fibrillation. Methodist Debakey Cardiovasc J 2015;11:100-3.
• 21. Knecht S, Sticherling C, von Felten S, Conen D, Schaer B, Ammann P, et al. Long-term comparison of cryoballoon and radiofrequency ablation of paroxysmal atrial fibrillation: a propensity score matched analysis. Int J Cardiol 2014;176:645-50.
• 22. Geidel S, Ostermeyer J, Lass M, Betzold M, Duong A, Jensen F, et al. Three years experience with monopolar and bipolar radiofrequency ablation surgery in patients with permanent atrial fibrillation. Eur J Cardiothorac Surg 2005;27:243-9.
• 23. Linhart M, Bellmann B, Mittmann-Braun E, Schrickel JW, Bitzen A, Andrié R, et al. Comparison of cryoballoon and radiofrequency ablation of pulmonary veins in 40 patients with paroxysmal atrial fibrillation: a case-control study. J Cardiovasc Electrophysiol 2009;20:1343-8.
• 24. Kojodjojo P, O'Neill MD, Lim PB, Malcolm-Lawes L, Whinnett ZI, Salukhe TV, et al. Pulmonary venous isolation by antral ablation with a large cryoballoon for treatment of paroxysmal and persistent atrial fibrillation: medium-term outcomes and non-randomised comparison with pulmonary venous isolation by radiofrequency ablation. Heart 2010;96:1379-84.
• 25. Kühne M, Suter Y, Altmann D, Ammann P, Schaer B, Osswald S, et al. Cryoballoon versus radiofrequency catheter ablation of paroxysmal atrial fibrillation: biomarkers of myocardial injury, recurrence rates, and pulmonary vein reconnection patterns. Heart Rhythm 2010;7:1770-6.
• 26. Kuck KH, Brugada J, Fürnkranz A, Metzner A, Ouyang F, Chun KR, et al. Cryoballoon or radiofrequency ablation for paroxysmal atrial fibrillation. N Engl J Med 2016;374:2235-45.
• 27. Hachem AH, Marine JE, Tahboub HA, Kamdar S, Kanjwal S, Soni R, et al. Radiofrequency ablation versus cryoablation in the treatment of paroxysmal atrial Fibrillation: a meta-analysis. Cardiol Res Pract 2018;2018:6276241.