Page 35 - ADD-ON ABLATION SURGERY IN PATIENTS WITH ATRIAL FIBRILLATION

septum and behind the right atrial appendage, which were used for evaluating the
conduction block as well as for rate-control in the postoperative period. Before
starting the ablation therapy, epicardial cardioversion was attempted up to three
times to bring the patient into SR in order to facilitate evaluation of the ablation
effect.The off-pump beating heart ablation procedure was performed according 2 to the following protocol:
- Epicardial electrical conversion to SR
- Positioning of the temporary pacing wires
- Opening of the pericardial reflection between the inferior right pulmonary
vein and the inferior caval vein into the oblique sinus
- Opening of the pericardial reflection between the superior right pulmonary
vein and the superior caval vein and opening of the oblique sinus and
transverse sinus
- Dissection of the intra-atrial groove and removal of fat tissue
- Removal of fat tissue at the roof of the left atrium in the transverse sinus
- Resection of the left atrial appendage
- Positioning of a sling through the transverse sinus
- Positioning of a second sling from the inferior pulmonary vein through the
oblique sinus into the transverse sinus
- Surgical ablation according to the line set in Figure 1
- Verification of the conduction block
Clinical follow-up
AF during in-hospital follow-up was treated according to predefined protocols (prophylactic Sotalol for at least four weeks postoperatively, additional Digoxin for rate control, oral anticoagulants for at least 3 months depending on rhythm oucome, cardioversion after three days of persistent AF).At least for the first five postoperative days patients had continuous cardiac monitoring at the inpatient ward. Atrial arrhythmia in the follow-up period out of hospital, was treated by the patients’ own cardiologist (rate control and cardioversion), instead of by a predefined protocol, who was also blinded to the allocated treatment during the 12-month study period. Oral anticoagulant therapy was started on the first postoperative day and continued for three months in case of mechanical valve implantation or other non-AF-related disease.All patients used oral anticoagulants as long as they were in AF. If none of these premises applied, patients received low-dose aspirin (100mg/daily). There were no restrictions with respect to
Quality of life after cardiac surgery
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