Energy Sources for Atrial Fibrillation Surgery
An energy source is used in both open-heart maze surgical ablations and closed-chest minimally invasive (mini maze) afib surgeries to create scar tissue that blocks abnormal electrical activity. The lines of scarred tissue are called lesion lines or ablation lines. Research has proven that surgical ablation is nearly as effective as cut-and-sew surgeries but is much faster to accomplish.
In the earliest surgeries, surgeons had to estimate the time required for ablation, which varied by patient due to differences in heart wall thickness. Newer devices measure electrical conductivity and determine whether the ablation line is transmural, which means that conduction block has been achieved.
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A variety of surgical ablation energy sources may be used:
- Non-irrigated (dry) bipolar radiofrequency—uses a clamp to deliver radiofrequency (RF) energy. It measures the transmurality of the lesion to determine when conduction block at the pulmonary veins is achieved. Bipolar devices are more effective than unipolar ones, with transmurality that has approached 100% in numerous studies. In addition, bipolar devices are generally larger and just slightly more invasive than unipolar ones.
- Irrigated (wet) bipolar radiofrequency—uses radiofrequency (RF) energy. It adds saline to cool the surface and let the heat go deeper into the tissue. There is a research study indicating a 100% rate of transmurality.
- Unipolar (wet or dry) radiofrequency—unipolar devices are smaller and more flexible. Still, they are not as thorough in creating transmural lesions and have been involved in some injuries to the esophagus.
- Cryoablation (cryothermy)—uses cold temperatures to freeze the tissue. It doesn’t produce charring or vaporization of tissue. Ice spreading has been reported as a problem but without reported consequences.
To learn more about hybrid procedures that combine minimally invasive surgery and catheter ablation, see Hybrid Ablation Procedures.
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