Combined Bipolar/Unipolar Radiofrequency Maze is Superior to Unipolar Maze in Concomitant Surgery

Atrial fibrillation is the most common arrhythmia with significant morbidity and mortality. Radiofrequency (RF) ablation, despite its shortcomings, remain an acceptable and ‘simple’ technique.Methods: We reviewed 137 consecutive concomitant irrigated RF modified maze procedures, and compared the outcomes of 65 patients undergoing Unipolar-RF versus 72 patients using the combined Uni/Bipolar-RF approach. All patients were prospectively followed clinically, with serial electrocardiography and selective echocardiography. One hundred and twenty-two patients (89.1%) underwent mitral valve procedures, and eight coronary bypass, and seven adult congenital operations were performed.Results: The predominantly male (54.7%) patients had a mean age of 58.3±11.5 years (23–88 years). At median follow-up of 3.21 years (0.01–6.06 years), 15 (10.9%) patients were lost to follow-up. Freedom from AF in the Uni/Bipolar-RF group was higher at six months: 85.1% (57/67) versus 65% (39/60) in the Unipolar-RF group (P=0.012). This superior trend persisted at five years: 100% (5/5) in the Uni/Bipolar-RF group versus 79.5% (31/39) in the Unipolar-RF group, although this is not statistically significantly (P=0.566). Patients with left atrial dilatation beyond 7.6cm were more likely to remain in AF (OR 0.44, 95% CI, 0.19–1.00, P=0.049). Perioperative mortality was 2.9%. There was no collateral damage by the device and procedure. The mean survival for patients AF-free at last follow-up is 5.73 years (95% CI, 5.48–5.98), comparable to 5.58 years (95% CI, 5.07–6.10) in those remaining in AF. Thirty (22.6%) patients were completely off anti-arrhythmic medication while 36 (25.6%) were anticoagulant-free.Conclusion: The combined Uni/bipolar-RF modified bi-atrial Maze technique is simple, safe and superior to isolated Unipolar-RF ablation. Midterm results continue to support its use although long-term durability remains to be elucidated.