Ablation procedures are recommended in
the guidelines for patients with AF undergoing
open heart surgery.[
7] Electrophysiological studies
performed during the operation show that the
focus of AF is concentrated in the orifice of the left
atrium appendix and the left pulmonary veins, and
in some patients, the focus is in the right pulmonary
vein orifice.[
8-
10] Based on previous study findings,
isolated left atrial appendix procedures have been
increasingly used.[
11,
12]
In our study, no significant difference was found
between the two techniques. In similar studies in the
literature, the rate of establishing the sinus rhythm
was about 63 to 92% with radiofrequency ablation and
59 to 82% with cryoablation,[6,13] consistent with our
study results. However, delayed return to sinus rhythm
was observed in long-term follow-up patients who
were ablated for AF.[14,15]
Although there are many studies using energy
sources and procedures, no consensus has been
established, yet. Previous studies using similar
methods demonstrated similar rates of sinus
node dysfunction, nodal rhythm, and complete
atrioventricular block (AV) block rates in the early
postoperative period. In our study, no atrial flutter
was seen, compared to the other studies, which was
found to be 4 to 6% of occurrence.[16-18] Meta-analyses
showed that the rate of permanent pacemaker
requirement in patients undergoing radiofrequency ablation procedure ranged from 0 to 10% and the
rate of patients who required permanent pacemakers
in patients undergoing cryoablation procedure
was 0 to 21%.[7,13] In our study, two patients
who underwent radiofrequency ablation required
permanent pacemaker implantation due to complete
AV block; however, none of the cryoablation patients
required permanent pacemaker.
In the literature, isolated left atrial ablation-related
complications such as esophageal injury, trachea
injury, circumflex artery injury, and pulmonary
vein stenosis have been reported.[19-22] It was also
shown that patients undergoing maze procedure had
longer hospitalizations, but there were no differences
between the ablation methods.[23] In our study, these
complications were not encountered, although the
need for inotropic support was found to be higher
with longer intensive care unit and hospital stay in
the patients who underwent radiofrequency ablation
than cryoablation. In another study, the risk of
thromboembolism was found to be higher in the
radiofrequency ablation group than cryoablation,[24]
although thromboembolism complications were not
seen in both methods in our study.
In conclusion, our study results suggest that
radiofrequency ablation and cryoablation can be used
in patients with atrial fibrillation scheduled for open
heart surgery. The success rate of both techniques is
also similar in our study. However, further, large-scale
and long-term studies are needed to fully elucidate the
effects of both energy sources.
Declaration of conflicting interests
The authors declared no conflicts of interest with respect
to the authorship and/or publication of this article.
Funding
The authors received no financial support for the research
and/or authorship of this article.