Introduction: We studied whether a combined surgical radiofrequency LA box lesion set, performed prior to cardiopulmonary bypass, coupled with post-operative EP study and additional catheter based lesion sets, would be safe and efficacious in high-risk surgical pts with AF, cardiomyopathy, and giant LA’s. AF ablation is deemed too risky in these pts, but restoration of NSR may be critical to short and long-term survival. Epicardial Ablation pre-bypass, followed by catheter ablation post op (Hybrid Approach), would eliminate the additional ischemia and bypass time, yet restore NSR if effective.
Methods: Twelve (12) pts, aged 58-84, with EF’s Results: Ten/12 pts (83%) developed AF or Aflutter post-op. Four/10 (40%) were studied acutely and found to have RA flutter, which was ablated. One/11 required a second intervention for a left sided RA. Six/10 (60%) either converted or were cardioverted. Four/12 (33%) required permanent pacemaker implant for bradycardia. There were no deaths. At followup, 2/12 (16%) have persistent A Flutter with rate control.
Conclusions: We conclude that the Hybrid approach to the treatment of AF in pts with giant LA’s and cardiomyopathy using an Epicardial LA Box lesion set, performed off pump with Bipolar and Unipolar Radiofrequency Ablation prior to cardiac surgery, is safe and efficacious in these high risk pts; restoring sinus rhythm in 84% at up to 2 year followup.