New ablation techniques for atrial fibrillation and the minimally invasive cryo-maze procedure in patients with lone atrial fibrillation.

Atrial fibrillation (AF) is associated with significant morbidity and mortality. Medical management is often palliative but new ablation techniques have enabled curative approaches. Catheter-based ablation has limited success, whilst surgical approaches are widely applicable with favourable results. The minimally invasive Cryo-Maze (MICM) replicates the lesions of the Cox-Maze procedure using cryotherapy. We present our retrospective review of all Cryo-Maze procedures performed at East Carolina University, from October 2003 to January 2006, with analysis of all MICM's for lone AF, via a small right inframammary incision. A total of 41 patients (29 male, 12 female, age 61.6+/-9.7 years) with lone AF underwent an MICM as a primary operation. There were no deaths or early or late strokes. At discharge 36 patients (87.8%) were in sinus. At six weeks, this ratio had increased to 90.2% (37/41). The rate of SR continued to improve and for those out three months, the rate increased to 92.7% (38/41). At six months, 87.2% (34/39) were in SR. SR was seen in 20/23 patients with follow-up beyond one year (87.0%). In conclusion, surgical ablation techniques that replicate the Cox-Maze procedure are associated with high rates of sinus rhythm beyond one year, with wide application. AF is a curable condition, using a combination of catheter-based and surgical approaches. Newer surgical ablation devices allow minimally invasive approaches.