Strategies in the Surgical Management of Atrial Fibrillation

Table 3

Summary of results from alternative ablative technique.

Study	Modality	𝑛	Lesion set	Approach	Lone or concomitant	Type of AF and aetiology	Mean f/u ± SD (months)	Freedom from AF	Mortality at last f/u
Vicol et al., 2008 [21]	Microwave	41	Left atrial (endocardial)	Median sternotomy	Concomitant	Permanent	5.37 ± 0.91	39.3%; at 5 years	17%
Pruitt et al., 2007 [22]	Microwave	100	PVI + LAA line	Thoracoscopic	Lone	Paroxysmal (64%); Persistent (11%); Permanent (25%)	23.1	42%; at last followup	3%
Topkara et al., 2006 [20]	Microwave	85	PV lesion 98.8%; Mitral annulus lesion 68.2%; LA ablation 32.9%; Flutter lesion 15.3%	Median sternotomy 78.8%; Minimally invasive 21.2%	Concomitant 99%; Lone 1%	Persistent	16.8 ± 12	66.7%; at 12 months	3.5%; 30 day mortality
	Radiofrequency	120	PV lesion 94.2%; Mitral annulus lesion 64.2%; LA ablation 65.8%; Flutter lesion 30.0%	Median sternotomy 95.0%; Minimally invasive 5.0%			9.6 ± 7.2	71.4%; at 12 months	3.4%; 30 day mortality
Knaut et al., 2006 [23]	Microwave	59	PVI + mitral annulus; (Allessie's lesion set, endocardial)	Median sternotomy	Concomitant	Permanent	—	52%; at 1 year	11.5%; at 1 year
	Microwave	43	PV box lesion + LAA line (endocardial)					74%; at 1 year
Molloy 2005 [24]	Microwave	29	Left Atrial + Ligament of Marshall (epicardial)	Median sternotomy	Concomitant	Permanent 86%; Paroxysmal 14%	315 days	82% at mean followup	3.6%
Hurlé et al., 2004 [25]	Microwave	9	Biatrial (endocardial)	Median sternotomy	Concomitant	Permanent	5.2 ± 3.3	62.5% at mean followup	11%
Wisser et al., 2004 [26]	Microwave	23	Biatrial (endocardial)	Median sternotomy	Concomitant	Permanent	24.2 ± 1.3	*81%; at 12 months	8.7%
	Radiofrequency	29					12.1 ± 1.2	*80%; at 12 months	0%
Mitnovetski et al., 2009 [27]	High frequency ultrasound	10	Epicardial	Median sternotomy	Concomitant	Permanent 71%	9 (3–13)	75% at mean followup	7.1%
		4				Paroxysmal 29%		78% at mean followup
Topkara et al., 2006 [20]	Microwave	143	PV lesion 96.8%; Mitral Annulus 48.7%; LAA 33.0%	Median sternotomy	Concomitant 96.8%; Lone	Persistent 75.8%; Paroxysmal	Recorded data at 3, 6, 12, and 24 months followup	75.3%	4.9% postoperative
	Radiofrequency	169	Flutter lesion 17.7%; PV box lesion only 41.9%					73.8%
	Laser	27	(82.9% endocardial; 17.9% epicardial)					71.4%
Baek et al., 2006 [28]	Cryoablation	93	Cox Maze III	Median sternotomy	Concomitant	Chronic	26.6 ± 15.2	84%	3.2%
		77	Kosakai-Maze					86% at last followup	1.3%
Gillinov et al., 2006 [29]	Cryoablation	31	PVI alone	Median sternotomy	Concomitant	Paroxysmal	Median 13.5	Prevalence of AF of flutter 9% at 1 year f/u	8.5% at 6 months
		80	PVI + connecting lesions
		41	Cox Maze III
Chen et al., 2001 [30]	Cryoablation and Radiofrequency	13	Maze II, III	Median Sternotomy	Concomitant	Chronic	3 Months	73% at 3 months	15.4%
		48	Maze IV					81% at 3 months	2.1%
		58	No Maze (Control)					11% at 3 months	6.9%

*Sinus Rhythm: Microwave—59.0% at 12 months; 60.0% at 24 months; Radiofrequency—57.1% at 12 months.