The CURE-AF trial: a prospective, multicenter trial of irrigated radiofrequency ablation for the treatment of persistent atrial fibrillation during concomitant cardiac surgery.

Abstract

BACKGROUND:

Ablation technology has been introduced to replace the surgical incisions of the Cox-Maze procedure in order to simplify the operation. However, the efficacy of these ablation devices has not been prospectively evaluated.

OBJECTIVE:

The purpose of this study was to examine the efficacy and safety of irrigated unipolar and bipolar radiofrequency ablation for the treatment of persistent and long-standing persistent atrial fibrillation (AF) during concomitant cardiac surgical procedures.

METHODS:

Between May 2007 and July 2011, 150 consecutive patients were enrolled at 15 U.S. centers. Patients were followed for 6 to 9 months, at which time a 24-hour Holter recording and echocardiogram were obtained. Recurrent AF was defined as any atrial tachyarrhythmia (ATA) lasting over 30 seconds on the Holter monitor. The safety end-point was the percent of patients who suffered a major adverse event within 30 days of surgery. All patients underwent a biatrial Cox-Maze lesion set.

RESULTS:

Operative mortality was 4%, and there were 4 (3%) 30-day major adverse events. Overall freedom from ATAs was 66%, with 53% of patients free from ATAs and also off antiarrhythmic drugs at 6 to 9 months. Increased left atrial diameter, shorter total ablation time, and an increasing number of concomitant procedures were associated with recurrent AF (P <.05).

CONCLUSION:

Irrigated radiofrequency ablation for treatment of AF during cardiac surgery was associated with a low complication rate. No device-related complications occurred. The Cox-Maze lesion set was effective at restoring sinus rhythm and had higher success rates in patients with smaller left atrial diameters and longer ablation times.

• Authors: Ralph J Damiano Jr, Vinay Badhwar, Michael A Acker, Ramesh S Veeragandham, David C Kress, Jason O Robertson, Thoralf M Sundt
• Journal: Heart rhythm (Heart Rhythm) Vol. 11 Issue 1 Pg. 39-45 (Jan 2014) ISSN: 1556-3871 [Electronic] United States
• PMID: 24184028 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © 2013 Heart Rhythm Society Published by Heart Rhythm Society All rights reserved.

Topics

• Aged
• Atrial Fibrillation (complications, physiopathology, surgery)
• Cardiac Surgical Procedures
• Catheter Ablation (methods, mortality)
• Echocardiography
• Electrocardiography, Ambulatory
• Female
• Follow-Up Studies
• Heart Conduction System (physiopathology, surgery)
• Humans
• Male
• Prospective Studies
• Survival Rate (trends)
• Therapeutic Irrigation
• Time Factors
• Treatment Outcome
• United States (epidemiology)