ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Cardiac Rhythmology
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1655695
Closed atrium bipolar radiofrequency box lesion for concomitant surgical atrial fibrillation ablation
Provisionally accepted
Simon Pecha1*
Johannes Petersen1,2
Yalin Yildirim1
Ilia Bazhanov1Hermann Reichenspurner1Yousuf Alassar1- 1University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- 2Standort Hamburg/Kiel/Lübeck, Deutsches Zentrum fur Herz-Kreislauf-Forschung eV, Berlin, Germany
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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.Between January 2023 and June 2024, 22 patients underwent the closed atrium radiofrequency 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.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.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.
Keywords: Atrial Fibrillation, Surgical ablation, Arrhythmia surgery, Left-atrial box lesion, AF surgery
Received: 28 Jun 2025; Accepted: 05 Aug 2025.
Copyright: © 2025 Pecha, Petersen, Yildirim, Bazhanov, Reichenspurner and Alassar. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Simon Pecha, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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