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Updated: Sep 9, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Closed atrium bipolar radiofrequency box lesion for concomitant surgical atrial fibrillation ablation
Simon Pecha1,2, Johannes Petersen1,2, Yalin Yildirim1
1Department of Cardiovascular Surgery, University Heart Center Hamburg, Hamburg, Germany.
Insights
This study introduces a new closed-atrium technique for surgical ablation of atrial fibrillation (AF) during heart surgery. The method safely isolates the left atrium, showing high success rates for AF freedom post-procedure.
Area of Science:
- Cardiac Surgery
- Electrophysiology
- Minimally Invasive Techniques
Background:
- Atrial fibrillation (AF) is common in patients undergoing cardiac surgery like coronary artery bypass grafting (CABG) or aortic valve replacement (AVR).
- Surgical ablation of AF is beneficial, especially for persistent AF, but surgeons often avoid opening the left atrium.
- A complete box lesion isolating the posterior left atrial wall is a key target for effective AF ablation.
Purpose of the Study:
- To evaluate the initial experience with a novel closed-atrium bipolar radio-frequency left atrial box ablation technique.
- To assess the technical feasibility, safety, and efficacy of this approach as a concomitant procedure during CABG or AVR.
- To determine the success rate of left atrial appendage (LAA) closure alongside AF ablation.
Main Methods:
- A cohort of 22 patients with AF undergoing CABG or AVR received the closed-atrium radio-frequency box lesion set between January 2023 and June 2024.
- Left atrial appendage (LAA) closure was performed using an LAA clip in all participants.
- The feasibility of creating a complete box lesion from the right side, and if necessary, the left side, was assessed. Safety and efficacy were evaluated through intraoperative and follow-up data.
Main Results:
- The mean age of patients was 67.9 years, with 68.2% being male. Persistent AF was present in 54.5% of patients.
- A complete box lesion was achieved in 14 patients from the right side, with 8 requiring completion from the left.
- No major ablation-related complications, periprocedural strokes, or in-hospital mortality occurred. AF freedom was 86.4% at discharge and 77.2% at 12.6 months follow-up. LAA closure was successful in all patients.
Conclusions:
- The closed-atrium left atrial box lesion technique is a safe and technically feasible option for surgical AF treatment during CABG or AVR.
- This method allows for complete isolation of the posterior left atrial wall without the need for direct left atrial opening.
- The technique demonstrates promising efficacy in achieving long-term freedom from atrial fibrillation.
Background:
In patients with atrial fibrillation (AF) undergoing coronary artery bypass grafting (CABG) or aortic valve replacement (AVR), many surgeons are reluctant to open the left atrium for surgical ablation. However, especially in those with persistent AF, a box lesion isolating the entire posterior left atrial wall may be beneficial. Here, we describe our initial experience with a novel closed atrium bipolar radio-frequency left atrial box ablation technique.
Methods:
Between January 2023 and June 2024, 22 patients underwent the closed atrium radio-frequency box lesion set. Left left atrial appendage (LAA) closure was performed using an LAA clip in all patients. We evaluated the technical feasibility, safety, and efficacy of this new concomitant surgical AF ablation approach.
Results:
The mean patient age was 67.9 ± 5.3 years, and 68.2% were male. 12 patients (54.5%) had persistent AF, while 10 (45.5%) had paroxysmal AF. Creation of a complete box lesion from the right side was feasible in 14 patients; in 8 patients, the lesion had to be completed from the left side. No major ablation-related complications occurred. Successful intraoperative LAA closure was confirmed by TEE in all patients. There were no periprocedural strokes, and in-hospital mortality was 0%. Freedom from AF was 86.4% at discharge and 77.2% at a mean follow-up of 12.6 ± 3.9 months.
Conclusion:
The closed atrium left atrial box lesion technique for surgical treatment of AF concomitant with CABG or AVR is safe and technically feasible. This approach enables complete isolation of the posterior left atrial wall without the need to open the left atrium.
