Surgical ablation for atrial fibrillation: The efficacy of a novel bipolar pen device in the cardioplegically arrested and beating heart Shun-ichiro.

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Presentation transcript:

Surgical ablation for atrial fibrillation: The efficacy of a novel bipolar pen device in the cardioplegically arrested and beating heart Shun-ichiro Sakamoto, MD, Rochus K. Voeller, MD, Spencer J. Melby, MD, Shelly C. Lall, MD, Nai-lun Chang, BA, Richard B. Schuessler, PhD, Ralph J. Damiano, MD The Journal of Thoracic and Cardiovascular Surgery Volume 136, Issue 5, Pages 1295-1301 (November 2008) DOI: 10.1016/j.jtcvs.2008.04.030 Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Isolator Transpolar Pen (AtriCure, Inc). The Journal of Thoracic and Cardiovascular Surgery 2008 136, 1295-1301DOI: (10.1016/j.jtcvs.2008.04.030) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Percentage transmural lesions versus ablation time in the atrial lesions in groups A (arrested heart) and B (beating heart). The Journal of Thoracic and Cardiovascular Surgery 2008 136, 1295-1301DOI: (10.1016/j.jtcvs.2008.04.030) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Relationship between ablation depth versus tissue thickness in groups A and B. The Journal of Thoracic and Cardiovascular Surgery 2008 136, 1295-1301DOI: (10.1016/j.jtcvs.2008.04.030) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 4 A, Example of a lesion near the tricuspid annulus. The asterisk indicates the ablation site on the endocardial surface. The ablation penetrates through the atrial tissue in the tricuspid annulus and reaches the epicardial fat tissue. B, Example of a lesion near the mitral annulus. The ablation penetrates through not only atrial tissue but also through the posterior wall of the coronary sinus. RCA, Right coronary artery; RV, right ventricle; TV, tricuspid valve; CS, coronary sinus; LV, left ventricle; MV, mitral valve. The Journal of Thoracic and Cardiovascular Surgery 2008 136, 1295-1301DOI: (10.1016/j.jtcvs.2008.04.030) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 5 Transmural lesion across both the coronary sinus and left atrial tissue after a 15-second ablation. The asterisk indicates the ablation surface of the coronary sinus. CS, Coronary sinus; LA, left atrium. The Journal of Thoracic and Cardiovascular Surgery 2008 136, 1295-1301DOI: (10.1016/j.jtcvs.2008.04.030) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions

Figure 6 A, Electrocardiographic recording during high-frequency stimulation before and after ablation. Continuous high-frequency stimulation was applied to the ventral ganglion plexus fat pad and induced R-R slowing (upper panel). After a 10-second ablation, high-frequency stimulation at the same voltage failed to induce R-R slowing. Asterisks indicate the start of high-frequency stimulation. Arrows indicate its duration. B, The depth of penetration is shown in the upper cartoon. The asterisk indicates the epicardial surface. The ablation did not fully penetrate the underlying atrial myocardium. The Journal of Thoracic and Cardiovascular Surgery 2008 136, 1295-1301DOI: (10.1016/j.jtcvs.2008.04.030) Copyright © 2008 The American Association for Thoracic Surgery Terms and Conditions