Background and aim of the study: Although the use of new sources of energy for the ablation of atrial fibrillation (AF) has simplified the procedure, concerns have been expressed with regard to the safety and efficacy of the various devices. Herein are described the results of a technique using a combination of bipolar radiofrequency (RF) and cryoablation.
Methods: Between February 2004 and August 2005, the combined procedure was used on 60 patients, 32 of whom (54%) had persistent AF, and 28 (46%) permanent AF. Lesions set similar to the Maze III procedure were used, with the addition of a right atrial isthmus lesion in the area of the coronary sinus and without right atrial appendage amputation and septal lesion.
Results: There were no operative complications and no death or major morbidity. The mean duration of the ablation procedure was 30 min (range: 27-36 min) for

biatrial procedures, and 16 min (range: 15-19 min) for left atrial procedures. Forty-two patients (70%) were discharged in sinus rhythm. On completion of follow up, 48 patients (80%) were in sinus rhythm. Among 45 patients treated with cryoablation rather than monopolar RF, 89% were in sinus rhythm at the mean follow up of nine months. The predictor for recurrent post-procedural AF was preoperative permanent AF for more than 10 years’ duration (p = 0.039), while that for postoperative atypical flutter was use of the monopolar RF ablator rather than the cryoablator (p = 0.001).
Conclusion: The use of a bipolar RF device with the cryoprobe is an appealing combination which enables the Maze III lesion set to be completed in a straightforward, safe, and efficient manner.

The Journal of Heart Valve Disease 2006;15:664-670