CARDIOVASCULAR JOURNAL OF AFRICA • Vol 21, No 3, May/June 2010
AFRICA
141
restored sinus rhythm without atrial flutter in any during the
postoperative period. Therefore we tend to favour isolated left
atrial ablation for the future. Although right-atrial interventions
do not significantly increase the success of the procedure, they
increase the duration of ischaemia and cardiopulmonary bypass
and necessitate an additional atrial incision, all of which may
pose additional risks.
Complications related to radiofrequency ablation have been
due to unipolar procedures. Particularly during left atrial abla-
tion, the oesophagus, circumflex coronary artery or left main
bronchus may be injured and bleeding due to left atrial perfora-
tion may develop. Among these, oesophageal injury is the most
fatal.
24
Another disadvantage of the unipolar catheter is the
definitive lack of transmurality. On the other hand, the bipolar
system assures a controlled and definitive transmural lesion, thus
excluding this disadvantage. However, no significant difference
could be found between the two methods with regard to success
rates in treating atrial fibrillation.
The peri-operative presence of AF does not indicate failure
of the procedure. In the present study, among the 15 patients
discharged with AF, 10 returned to normal sinus rhythm at three
months. On the other hand, nine patients discharged with sinus
rhythm developed AF within the first three months. This may be
critical with regard to the long-term success of the procedure in
preventing the recurrence of AF. Therefore postoperative prophy-
laxis for AF is important. We could provide medical cardiover-
sion in five out of seven patients who postoperatively developed
AF despite receiving amiodarone, by adding sotalol. Therefore
the amiodarone-plus-sotalol combination rather than amiodarone
alone may be effective in preventing postoperative recurrences of
atrial fibrillation.
Several investigators reported an association between atrial
size and success rate, however this finding has not been
confirmed by others.
12,19
In the present study, left atrial diameter
was greater in patients with persistent AF, although the differ-
ence did not reach statistical significance.
The main finding of this study was the importance of the
concomitant ablation procedure in patients with mitral valve
disease. Although the results were similar to the previous reports
discussed above, this study constitutes an important contribution
to the literature on using ablation with partial lesions.
Conclusion
Isolated left atrial radiofrequency ablation effectively treats AF
without significantly increasing the duration of cardiopulmonary
bypass and without specific complications due to the procedure
itself. This procedure demonstrates that AF may be successfully
treated by creating a partial lesion, rather than a complete lesion
as in the Cox-Maze III procedure.
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