CAVOTRICUSPID ISTHMUS CRYOABLATION IS AS ONE OF THE MAIN STAGE FOR THE COX-MAZE PROCEDURE

Komarov Roman Nikolaevich, Nuzhdin Mikhail Dmitrievich, Matsuganov Denis Alekseevich, Bystrov Dmitry Olegovich

Atrial flutter (Afl) is one of the most common arrhythmias, second after atrial fibrillation (AF). The “gold standard” of Afl treatment is radiofrequency ablation of the cavotricuspid isthmus (CTI). However, that is not possible in patients with AF and mitral valve disease who require open combined surgery. So, the aim of this work is to evaluate the effectiveness of performing cryoablation line on CTI as one of the stages of the “Cox-MAZE” procedure as a method of treating and preventing the development of Afl. Aim. To evaluate the effectiveness of performing cryoablation line on CTI as one of the stages of the “Cox-MAZE” procedure as a method of treating and preventing the development of Afl. Methods. During the period from January 2019 to December 2022, based on the Department of Cardiac Surgery of the Chelyabinsk Regional Clinical Hospital, 49 patients, with mitral valve disease and AF, who underwent biatrial Cox-maze cryoablation procedure and mitral valve surgery. Afl before surgery occurred in 16 (32.7%) patients. The primary endpoint was the assessment of the development of Afl in the postoperative period. Secondary endpoints were the development of complications in the early postoperative period (need a permanent pacemaker, stroke, surgical infection, myocardial infarction, mortality). Results. The LA dimension was 5.4 [5.0-5.6] cm. and the RA was 5.7 [5.2-6.4] cm. The aortic cross clamping and cardiopulmonary bypass were 148 [132-164] and 190 [170-206] minutes, respectively. The ablation time for all lines was 11.0 [9.5–13.0] minutes. Sinus rhythm before discharge was restored in 46 (93.9%) patients. Afl developed in 6 (12.2%) patients in the early postoperative period. The need a permanent pacemaker - 2 (4.08%) cases. Conclusion. According to the results of our study, the effectiveness of performing an ablation line on CTI was demonstrated. The incidence of AfL in the postoperative period was 6.8%, and for those who did not undergo a line for CTI, 60.0% (p=0.01). The chances of developing Afl in patients with the performance this line were 20.4 times lower than in patients without line on CTI (95% CI: 2.42-166.6). There were no statistically significant differences dependence on the atrial flutter development in the postoperative period from tricuspid valve repair (p=0.97).

Keywords:atrial flutter, atrial fibrillation, cavotricuspid isthmus cryoablation, Cox-maze procedure