eISSN: 1897-4252
ISSN: 1731-5530
Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery
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1/2020
vol. 17
 
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abstract:
Original paper

The influence of epicardial and endocardial use of cryoenergy on the completeness of lesions in surgical ablation of atrial fibrillation

Vojtech Kurfirst
1
,
Julia Csanady
1
,
Ales Mokracek
1
,
Jiri Hanis
1
,
Alan Bulava
1
,
Ladislav Pesl
1

  1. Department of Cardiac and Thoracic Surgery, Hospital of České Budějovice, České Budějovice, Czech Republic
Kardiochir Torakochir Pol 2020; 17 (1): 29-32
DOI: https://doi.org/10.5114/kitp.2020.94188
Online publish date: 2020/04/07
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Introduction
Cryoenergy is the most commonly used method of lesion formation in patients who have undergone surgical ablation of atrial fibrillation. Despite frequent use, the clinical effect of cryoenergy in endocardial and epicardial approaches is unknown.

Aim
To compare the effect of various cryoenergy applications on the postoperative incidence of sinus rhythm and completeness of lesions performed.

Material and methods
A total of 55 patients underwent concomitant atrial fibrillation surgical ablation using cryoenergy under various conditions: epicardially during cardiac arrest, epicardially on beating heart, and endocardially. In the postoperative period, patients were invited to attend an electrophysiological examination to assess the completeness of surgical ablation lesions and, if necessary, to complete catheter ablation.

Results
Twenty-four patients underwent epicardial ablation on the arrested heart (group 1), 12 patients underwent epicardial ablation on the beating heart (group 2), and 19 patients underwent endocardial ablation (group 3). In the electrophysiological examination, sinus rhythm was present in 71% vs. 83% vs. 89% of patients, respectively. The completeness of pulmonary vein isolation was confirmed in 31% vs. 25% vs. 95% of patients, complete box lesions in 15% vs. 0% vs. 79% of patients, respectively.

Conclusions
Despite the similar clinical effect of surgical ablation in all three approaches, the morphologically most effective use of cryoenergy is endocardial ablation. This approach has a very good result. Our findings further support the endocardial use of cryoenergy during surgical ablation of atrial fibrillation.

keywords:

atrial fibrillation, cryoenergy, surgical ablation
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