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(Circulation. 2005;112:I-20 – I-25.)
© 2005 American Heart Association, Inc.

Arrhythmia Surgery

Effectiveness of the Maze Procedure Using Cooled-Tip Radiofrequency Ablation in Patients With Permanent Atrial Fibrillation and Rheumatic Mitral Valve Disease

Carlos A.C. Abreu Filho, PhD; Luiz A.F. Lisboa, PhD; Luís A.O. Dallan, PhD; Guilherme Sobreira Spina, PhD; Max Grinberg, PhD; Maurício Scanavacca, PhD; Eduardo A. Sosa, PhD; José Antonio F. Ramires, PhD; Sérgio A. Oliveira, PhD

From The Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.

Correspondence to Dr Abreu Filho, Rua Tangara, 304, Apto 222, Vila Mariana São Paulo, SP, Brazil 04019-030. E-mail carlosabreu{at}incor.usp.br

Background— Although the Cox-Maze III procedure is effective for treating permanent atrial fibrillation (AF), its high complexity limits its use. The Saline-Irrigated Cooled-tip Radiofrequency Ablation (SICTRA) System is an alternative source of energy used to ablate AF. The aim of this study was to evaluate the effectiveness of the SICTRA for the treatment of permanent AF in patients with rheumatic mitral valve (MV) disease.

Methods and Results— Between February 2002 and April 2003, 70 patients with permanent AF and rheumatic MV disease were randomly assigned to undergo a modified Maze III procedure using SICTRA associated with MV surgery (group A) or MV surgery alone (group B). Groups A and B were similar in terms of baseline characteristics. The in-hospital mortality rate was 2.3% (1 death) in group A versus 0% (no deaths) in group B (P>0.99). The additional time required for the left-sided radiofrequency ablation in group A was 14.2±5.1 minutes and for right-sided ablation was 12.3±4.2 minutes. The mean postoperative follow-up periods were 13.8±3.4 and 11.5±7.3 months, respectively, in groups A and B. The overall mid-term survival rate was 95.1% in group A and 92.8% in group B (P>0.99). The cumulative rates of sinus rhythm were 79.4% in group A and 26.9% in group B (P=0.001). Doppler echocardiography documented biatrial transport function in 90.3% of group A patients in sinus rhythm.

Conclusions— The SICTRA is effective for treating permanent AF associated with rheumatic MV disease.

Key Words: atrial fibrillation • ablation • mitral valve