Fibrilación auricular: manejo quirúrgico con ablación por radiofrecuencia. Experiencia en el Servicio de Cirugía Cardiovascular del CMN 20 de Noviembre del ISSSTE

Background: Atrial fibrillation is the most frequent cardiac arrhythmia that increases with aging and with some left valve disease, especially those of mitral location. Recently, therapeutic resources for the correction of this condition have increased, among which the surgical aspect plays a key role. Objective: To evaluate the effectiveness of the endocardic ablation by radio-frequency at the Service of Cardiovascular Surgery of CMN 20 de Noviembre, ISSSTE. Patients and method: We made an observational, longitudinal, descriptive and retrolective study at CMN 20 de Noviembre, ISSSTE. We reviewed the evolution of the cases of mitral valve operated from January 2006 to January 2007 with atrial fibrillation. These patients underwent to an ablation with radiofrequency in transoperatory period. Results: We included 25 patients, 16 women, with age of 34 to 71 years (average of 53.9 ± 9.5), 9 with double mitral injury, 13 with double mitral injury plus tricuspid insufficiency and 3 with intra-auricular thrombus in addition to diagnoses previously mentioned. Average time of the atrial fibrillation was 14.4 months, the size of the left auricle was of 51.5 to 88.5 mm, with an average of 66 ± 9 mm; the waves of fibrillation were predominantly smaller than 1 mm (0.95 mm); time of clamp was 44 to 53 min, with an average of 91.1 ± 21.6, and pump from 211 to 66 min, with an average of 113.8 ± 32.3 min; the time of follow-up was 5-18 months, with an average of 10.7 ± 3.9, and the percentage of patients that maintained sinusal rate was of 76% to 18 months. Conclusions: We concluded that the endocardic ablation by radiofrequency is a simple method that allows the aggression in an important percentage of the patients with atrial fibrillation that require, in addition, surgery to mitral valve, this substantially does not prolong the time of clamp and pump and increases in non significant way the morbidity of the patients who underwent cardiac surgery.