Reversão da fibrilação atrial crônica pela técnica do labirinto com aplicação de radiofreqüência e ultra-som transoperatórios

Abstract

The Cox Maze procedure has been used to restore the sinus rhythm in patients (pts) with chronic atrial fibrillation (CHF). Usually dissection and suture increase the operative time and postoperative complications. Hence, to avoid this we have used transoperative radiofrequency (RF) or ultrasound applications to create the lines. Since 1998, five pts. have been operated (3 females) with average age of 145.8 years. All suffered from valve disease and CAF. The peripheral leads were monitored and extracorporeal circulations initiated without cardioplegia. After opening the right atrium, the RF lesion lines were created using a modified Maze procedure. Regulation of the R-R and increase in the "F" waves, resembling an atypical atrial flutter accurred soon after. Following aortic clamping and left atrial opening the left auricle was isolated and the RF lines were done. After liberations of the aorta, the heart contracted spontaneously and retuned to sinus rhythm. After valve replacement and reduction of the left atrium, the ECG continued to record sinus rhythm. We have used ultrasound in our last two patients to procedure deeper and easier lesion lines. All pts. displayed sinus rhythm both in the early and late postoperative periods. All pts. were maintained on 120 gms/day of oral Verapamil to aid in atrial remodiling. In conclusion this technique has shortened the time necessary to accomplish the Maze procedure, reducing tissue damage and complications.

Resultados da ablação cirúrgica por radiofreqüência da fibrilação atrial crônica

“…At release from hospital, the reversal rate to sinusal rhythm was 81.4%. The same authors presented an experiment utilizing intra-operative radiofrequency [18].…”

Tratamento intra-operatório da fibrilação atrial crônica com ultra-som

“…Iniciou-se a casuística com a utilização da radiofreqüência, para realização das linhas de ablação intra-operatória (71) , com cateter de ablação, tendo sido operados 3 pacientes, com reversão ao ritmo sinusal.…”

Surgical Ablation of Atrial Fibrillation Using Energy Sources

“…The effects of ultrasound to treat AF are produced by tissue damage derived from hyperthermia in tissue necrosis, resulting in a transmural lesion that can be used in both endocardial and epicardial applications, in a minimally invasive manner. Considering the experience with the ultrasound scalpel (UltraCision ® ), often used in videolaparoscopic procedures [ 40 ] for treating refractory ventricular tachycardia, Brick et al [ 26 , 41 ] devised a new approach to form lines of lesions, which would determine the partitioning of the left and right atria under shorter surgical and cardiopulmonary bypass time, reflecting positively in postoperative complications.…”