Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지
DOI QR코드

DOI QR Code

Efficacy of Cox Maze IV Procedure Using Argon-Based Cryoablation: A Comparative Study with $N_2O$-Based Cryoablation

  • Lee, Kyung-Hak (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Min, Jooncheol (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Kim, Kyung-Hwan (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Hwang, Ho Young (Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine) ;
  • Kim, Jun Sung (Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine)
  • Received : 2013.10.22
  • Accepted : 2013.11.21
  • Published : 2014.08.05
Download PDF
⟨ Previous Next ⟩

Abstract

Background: We compared the mid-term results of the Cox maze IV procedure using argon-based cryoablation with a procedure using $N_2O$-based cryoablation. Methods: From May 2006 to June 2012, 138 patients (mean age, $58.2{\pm}11.0$ years) underwent the Cox maze IV procedure. Eighty-five patients underwent the maze procedure using an $N_2O$-based cryoprobe (group N), and 53 patients underwent the maze procedure using an argon-based cryoprobe (group A). Bipolar radiofrequency ablation was concomitantly used in 131 patients. The presence of atrial fibrillation immediately, 6 months, 1 year, and 2 years after surgery was compared. Results: Early mortality occurred in 6 patients (4.3%). There were no differences in early mortality or postoperative complications between the two groups. Nineteen of 115 patients (16.5%) remained in atrial fibrillation at postoperative 12 months (14 of 80 patients (17.5%) in group N and 5 of 35 patients (14.3%) in group A, p=0.669). There were no differences in the number of patients who remained in atrial fibrillation at any of the time periods except in the immediate postoperative period. A multivariable analysis revealed that the energy source of cryoablation was not associated with the presence of atrial fibrillation at 1 year (p=0.862) and that a fine F wave (<0.1 mV) was the only risk factor predicting the presence of atrial fibrillation at 1 year (p<0.001, odds ratio=20.287). Conclusion: The Cox maze IV procedure using an argon-based cryoprobe was safe and effective compared with the maze procedure using an $N_2O$-based cryoprobe in terms of operative outcomes and the restoration of sinus rhythm for up to 2 years after surgery.

Keywords

References

  1. Doty DB. Surgical treatment of atrial fibrillation. Heart Lung Circ 2004;13:280-7. https://doi.org/10.1016/j.hlc.2004.02.020
  2. Narayan SM, Cain ME, Smith JM. Atrial fibrillation. Lancet 1997;350:943-50. https://doi.org/10.1016/S0140-6736(97)06359-9
  3. Gillinov AM, Blackstone EH, McCarthy PM. Atrial fibrillation: current surgical options and their assessment. Ann Thorac Surg 2002;74:2210-7. https://doi.org/10.1016/S0003-4975(02)03977-2
  4. Fuster V, Ryden LE, Cannom DS, et al. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: excutive summary. Rev Port Cardiol 2007;26:383-446.
  5. Van Gelder IC, Hagens VE, Bosker HA, et al. A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation. N Engl J Med 2002;347:1834-40. https://doi.org/10.1056/NEJMoa021375
  6. Crijns HJ, Van Gelder IC, Van Gilst WH, Hillege H, Gosselink AM, Lie KI. Serial antiarrhythmic drug treatment to maintain sinus rhythm after electrical cardioversion for chronic atrial fibrillation or atrial flutter. Am J Cardiol 1991;68:335-41. https://doi.org/10.1016/0002-9149(91)90828-9
  7. Falk RH. Proarrhythmia in patients treated for atrial fibrillation or flutter. Ann Intern Med 1992;117:141-50. https://doi.org/10.7326/0003-4819-117-2-141
  8. Flaker GC, Blackshear JL, McBride R, Kronmal RA, Halperin JL, Hart RG. Antiarrhythmic drug therapy and cardiac mortality in atrial fibrillation. The Stroke Prevention in Atrial Fibrillation Investigators. J Am Coll Cardiol 1992;20:527-32. https://doi.org/10.1016/0735-1097(92)90003-6
  9. Ad N. The Cox-Maze procedure: history, results, and predictors for failure. J Interv Card Electrophysiol 2007;20:65-71. https://doi.org/10.1007/s10840-007-9176-z
  10. Kim JS, Lee JH, Chang HW, Kim KH. Surgical outcomes of Cox-maze IV procedure using bipolar irrigated radiofrequency ablation and cryothermy in valvular heart disease. Korean J Thorac Cardiovasc Surg 2011;44:18-24. https://doi.org/10.5090/kjtcs.2011.44.1.18
  11. Yanagawa B, Holmes SD, Henry L, Hunt S, Ad N. Outcome of concomitant Cox-maze III procedure using an argon-based cryosurgical system: a single-center experience with 250 patients. Ann Thorac Surg 2013;95:1633-9. https://doi.org/10.1016/j.athoracsur.2013.02.015
  12. Prasad SM, Maniar HS, Camillo CJ, et al. The Cox maze III procedure for atrial fibrillation: long-term efficacy in patients undergoing lone versus concomitant procedures. J Thorac Cardiovasc Surg 2003;126:1822-8. https://doi.org/10.1016/S0022-5223(03)01287-X
  13. McCarthy PM, Gillinov AM, Castle L, Chung M, Cosgrove D 3rd. The Cox-Maze procedure: the Cleveland Clinic experience. Semin Thorac Cardiovasc Surg 2000;12:25-9. https://doi.org/10.1016/S1043-0679(00)70013-X
  14. Haissaguerre M, Jais P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 1998;339:659-66. https://doi.org/10.1056/NEJM199809033391003
  15. Viola N, Williams MR, Oz MC, Ad N. The technology in use for the surgical ablation of atrial fibrillation. Semin Thorac Cardiovasc Surg 2002;14:198-205. https://doi.org/10.1053/stcs.2002.35292
  16. Damiano RJ Jr. Alternative energy sources for atrial ablation: judging the new technology. Ann Thorac Surg 2003;75:329-30. https://doi.org/10.1016/S0003-4975(02)04844-0
  17. Rahman NM, Chard RB, Thomas SP. Outcomes for surgical treatment of atrial fibrillation using cryoablation during concomitant cardiac procedures. Ann Thorac Surg 2010;90:1523-7. https://doi.org/10.1016/j.athoracsur.2010.05.037
  18. Rahmanian PB, Filsoufi F, Salzberg S, Coppolino A, Castillo JG, Adams DH. Surgical treatment of atrial fibrillation using cryothermy in patients undergoing mitral valve surgery. Interact Cardiovasc Thorac Surg 2008;7:990-5. https://doi.org/10.1510/icvts.2007.172668

Cited by

  1. Characteristics of the new AtriCure cryoFORM® cryoablation probe for the surgical treatment of cardiac arrhythmias vol.14, pp.4, 2014, https://doi.org/10.1080/17434440.2017.1309972
  2. Comparison of Radiofrequency Ablation and Cryoablation for the Recovery of Atrial Contractility and Survival vol.51, pp.4, 2014, https://doi.org/10.5090/kjtcs.2018.51.4.266