Mitral valve surgery with transseptal or septal-superior approaches combined with the intraoperative radiofrequency modified Maze procedure for the treatment of atrial fibrillation

Objective: the aim of our study was to evaluate the safety and efficacy of radiofrequency (RF) ablation as a surgical adjunct in the treatment of atrial fibrillation (AF) and to adapt the Maze principles to mitral valve (MV) surgery using the transseptal approach (TA) and the septal-superior approach (SSA). Design and Methods: from January 2001 to January 2004, 37 patients with permanent or persistent AF underwent an irrigated RF modified Maze procedure in combination with MV surgery. Patients were prospectively assigned to a TA group (26 patients) or a SSA group (11 patients). Results: All the patients underwent a bi-atrial RF modified Maze procedure. The total mean time of the RF Maze procedure was 21 ± 3 min (range 15–30 min). In-hospital mortality was 2.7% (1 patient). 35 patients were free of AF at discharge. All the patients reached the 12-month follow-up, no AF or flutter was observed in 29 patients (81%) and 18 of them received no antiarrhythmics. Permanent pacing was necessary in 19% of the SSA group patients and in 18% of the TA group patients. Doppler echocardiographic examination detected the transmitral A wave in 85% of patients at 6 months postoperatively. Conclusions: irrigated radiofrequency modified Maze procedure using both transseptal and septal-superior approaches is an effective and safe procedure abolishing atrial fibrillation in 81% of patients at 12 months of follow-up.