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Background: Modulation of the cardiac autonomic nervous system (ANS) is a promising adjuvant therapy in the treatment of atrial fibrillation (AF). In pre-clinical models, pulsed field (PF) energy has the advantage of selectively ablating the epicardial ganglionated plexi (GP) that govern the ANS. Objective: This study aims to demonstrate the feasibility and safety of epicardial ablation of the GPs with PF during cardiac surgery with a primary efficacy outcome of prolongation of the atrial effective refractory period (AERP). Methods: In a single-arm, prospective analysis, patients with or without a history of AF underwent epicardial GP ablation with PF during coronary artery bypass grafting (CABG). AERP was determined immediately pre- and post- GP ablation to assess cardiac ANS function. Holter monitors were performed to determine rhythm status and Heart Rate Variability (HRV) at baseline and at 1 month post-procedure. Conclusions: This study demonstrates the safety and feasibility of epicardial ablation of the GP using PF to modulate the ANS during cardiac surgery. Large, randomized analyses are necessary to determine whether epicardial PF ablation can offer a meaningful impact on the cardiac ANS and reduce AF. Results: Of 24 patients, 23 (96%) received the full ablation protocol. No device-related adverse effects were noted. GP ablation resulted in a 20.7% ± 19.9% extension in AERP (P < 0.001). Post-operative AF was observed in 7 (29%) patients. Holter monitoring demonstrated an increase in mean heart rate (74.0±8.7 vs 80.6±12.3, P=0.01). There were no significant changes in HRV. There were no study-related complications.

Objectives This study sought to evaluate the safety and feasibility of percutaneous retrieval of left atrial appendage closure (LAAC) devices with an endoscopic grasping tool. Background Transcatheter LAAC is a mechanical stroke prevention strategy in patients with nonvalvular atrial fibrillation (AF) who are poor candidates for long-term oral anticoagulation. However, these LAAC devices can be inadvertently released into an unfavorable location, the device might migrate to a different (unfavorable) position within the left atrial appendage (LAA) or may embolize from the heart into the aorta. In such instances, it can be challenging to remove the LAAC device without open cardiac or vascular surgery. Methods This study reports on a series of 4 cases in which an endoscopic grasping tool (Raptor) designed for gastrointestinal applications was used to percutaneously (non-surgically) remove LAAC devices that were either malpositioned or embolized. Results LAAC devices were safely and non-surgically removed using the grasping device in all 4 cases (Amulet: 1, Watchman: 3). Devices were successfully retrieved from the left inferior pulmonary vein, descending aorta, aortic arch, and the edge of the LAA ostium. Time of device retrieval post-LAAC implantation ranged from 24 h to 1 year. Special precautionary measures, such as preemptive pericardial access, embolic protection devices, and intraprocedural imaging, were used in 2 cases. Conclusions This case series demonstrated that the endoscopic grasping tool appeared to be safe and useful to percutaneously retrieve LAAC devices.

Objectives Ring annuloplasty reduces the septal-lateral diameter (SLD) indirectly by circumferential annular cinching and frequently results in the recurrence of mitral regurgitation (MR) in patients with functional MR (FMR). Our goal was to report the results from the trial and the 2-year post-trial surveillance data. We evaluated whether direct reduction of the SLD with a transannular mitral bridge could achieve significant and durable MR reduction in patients with FMR. Methods In a prospective trial, 34 consecutive patients with FMR had a mitral bridge implanted surgically. Primary end points were MR ≤1+ at 1, 3 and 6 months postimplant and freedom from subsequent surgical mitral valve repair or replacement. Results Thirty-two of 34 (94.1%) patients met the primary end points with MR ≤1+ at 6 months. At 2 years, there were no strokes or device-related adverse events. At 2 years, MR was reduced from 3.32 ± 0.47 to 0.50 ± 0.83 (P ≤ 0.001) with ≤1+ MR in 33/34 patients, including 4 reinterventions for periprosthetic recurrent MR ≥3 without mitral bridge explants or conventional mitral repair or replacement. At 2 years, the mean mitral gradient was 2.15 ± 0.82 mmHg; the mitral annular SLD decreased from 40.4 ± 2.91 mm to 28.9 ± 1.55 mm (P ≤ 0.001). The left ventricular ejection fraction increased (57.9 ± 10.4-62.4 ± 9.7%; P ≤ 0.001). The New York Heart Association functional class improved (2.19 ± 0.76-1.41 ± 0.61; P ≤ 0.001). Conclusions The single-centre trial data indicate that direct reduction in the SLD with a mitral bridge is feasible, safe and efficacious in patients with FMR. Validation in a larger population of patients and comparison to conventional annuloplasty ring are necessary. Clinical trial registration number NCT03511716.

Objectives The authors report the first acute clinical experience of atrial fibrillation ablation with PEF—both epicardial box lesions during cardiac surgery, and catheter-based PV isolation. Background Standard energy sources rely on time-dependent conductive heating/cooling and ablate all tissue types indiscriminately. Pulsed electric field (PEF) energy ablates nonthermally by creating nanoscale pores in cell membranes. Potential advantages for atrial fibrillation ablation include: 1) cardiomyocytes have among the lowest sensitivity of any tissue to PEF—allowing tissue selectivity, thereby minimizing ablation of nontarget collateral tissue; 2) PEF is delivered rapidly over a few seconds; and 3) the absence of coagulative necrosis obviates the risk of pulmonary vein (PV) stenosis. Methods PEF ablation was performed using a custom over-the-wire endocardial catheter for percutaneous transseptal PV isolation, and a linear catheter for encircling the PVs and posterior left atrium during concomitant cardiac surgery. Endocardial voltage maps were created pre- and post-ablation. Continuous and categorical data are summarized and presented as mean ± SD and frequencies. Results At 2 centers, 22 patients underwent ablation under general anesthesia: 15 endocardial and 7 epicardial. Catheter PV isolation was successful in all 57 PVs in 15 patients (100%) using 3.26 ± 0.5 lesions/PV: procedure time 67 ± 10.5 min, catheter time (PEF catheter entry to exit) 19 ± 2.5 min, total PEF energy delivery time Conclusions These data usher in a new era of tissue-specific, ultrarapid ablation of atrial fibrillation.

AIMS Surgical ventricular reconstruction to remodel, reshape, and reduce ventricular volume is an effective therapy in selected patients with chronic heart failure (HF) of ischaemic aetiology. The BioVentrix Revivent TC System offers efficacy comparable to conventional surgical ventricular reconstruction and is less invasive utilizing micro-anchor pairs to exclude scarred myocardium on the beating heart. Here, we present 12-months follow-up data of an international multicenter study. METHODS AND RESULTS Patients were considered eligible for the procedure when they presented with symptomatic HF [New York Heart Association (NYHA) class ≥II], left ventricular (LV) dilatation and dysfunction caused by myocardial infarction, and akinetic and/or dyskinetic transmural scarred myocardium located in the anteroseptal, anterolateral, and/or apical regions. A total of 89 patients were enrolled and 86 patients were successfully treated (97%). At 12 months, a significant improvement in LV ejection fraction (29 ± 8% vs. 34 ± 9%, P

The authors report the first acute clinical experience of atrial fibrillation ablation with PEF-both epicardial box lesions during cardiac surgery, and catheter-based PV isolation.Standard energy sources rely on time-dependent conductive heating/cooling and ablate all tissue types indiscriminately. Pulsed electric field (PEF) energy ablates nonthermally by creating nanoscale pores in cell membranes. Potential advantages for atrial fibrillation ablation include: 1) cardiomyocytes have among the lowest sensitivity of any tissue to PEF-allowing tissue selectivity, thereby minimizing ablation of nontarget collateral tissue; 2) PEF is delivered rapidly over a few seconds; and 3) the absence of coagulative necrosis obviates the risk of pulmonary vein (PV) stenosis.PEF ablation was performed using a custom over-the-wire endocardial catheter for percutaneous transseptal PV isolation, and a linear catheter for encircling the PVs and posterior left atrium during concomitant cardiac surgery. Endocardial voltage maps were created pre- and post-ablation. Continuous and categorical data are summarized and presented as mean ± SD and frequencies.At 2 centers, 22 patients underwent ablation under general anesthesia: 15 endocardial and 7 epicardial. Catheter PV isolation was successful in all 57 PVs in 15 patients (100%) using 3.26 ± 0.5 lesions/PV: procedure time 67 ± 10.5 min, catheter time (PEF catheter entry to exit) 19 ± 2.5 min, total PEF energy delivery time 60 s/patient, and fluoroscopy time 12 ± 4.0 min. Surgical box lesions were successful in 6 of 7 patients (86%) using 2 lesions/patient. The catheter time for epicardial ablation was 50.7 ± 19.5 min. There were no complications.These data usher in a new era of tissue-specific, ultrarapid ablation of atrial fibrillation.

Cardiac resynchronization (CRT) is the established therapy of chronic systolic heart failure in patients with intraventricular conduction delay—wide QRS complex.1,2 Approximately 30% of patients, however, do not respond to this therapy clinically; and in 50% of patients, CRT is not associated with left ventricular (LV) reverse remodeling.3 Left ventricular pacing lead position is closely associated with the response to CRT. Several methods have been advocated for optimization of its position. However, only two of them have been studied more extensively. One comprises echocardiographic local mechanical delay,4–8 while the other consists of time interval between the onset of QRS complex and local LV lead electrogram (EGM) during spontaneous ventricular activation (QLV).9–14 The evidence from observational studies is mounting that more optimal LV lead position (at the site of more delayed contraction and longer QLV) predicts better clinical response and reverses LV remodeling. Inappropriate LV lead position with QLV shorter than one-half of the QRS duration was associated with higher mortality in a small retrospective study.12 Reduced mortality and reduced heart failure hospitalization rate (combined endpoint) were observed in patients randomized to echocardiographically optimized LV lead position in the TARGET trial.4 Unlike transvenous LV lead implantation, which is limited by the anatomy of the coronary sinus and its tributaries, minimally invasive surgical video-thoracoscopic approach has fewer constraints. In such situations, empirical selection of the LV pacing site, which is usually a central lateral segment of the LV according to previous hemodynamic studies,15,16 and endocardial activation mapping in patients with left bundle branch block (LBBB),17 may not be optimal. Therefore, we proposed a new method for fast epicardial mapping of QLV during video-thoracoscopic surgery to optimize the LV lead position. This study was primarily aimed at assessing the feasibility and safety of this approach. In addition, we hypothesized that the benefit of this technique could be indirectly demonstrated.

A new technique described as Less Invasive Ventricular Enhancement (LIVE) was performed to reduce volume and reshape the left ventricle without cardiopulmonary bypass in post-myocardial infraction, ischemic cardiomyopathy heart failure patients. Access in the early stages was via median sternotomy

Background: Congestive heart failure negatively impacts the prognosis in patients after cardiac surgery. The aim of our study was to assess the value of targeted cardiac resynchronization therapy (CRT) within 72 hours after cardiac surgery in patients with mechanical dyssynchrony, who had an ejection fraction ≤ 35%, QRS ≥150 ms or between 120 and 150 ms. Methods: A prospective randomized trial based on three-dimensional echocardiography (RT3DE) and optimized sequential dual-chamber (DDD) pacing in patients after cardiac surgery. DDD epicardial pacing (Medtronic coaxial epicardial leads 6495) was provided by a modified Medtronic INSYNC III Pacemaker (Medtronic Inc., Minneapolis, MN, USA). Summary of results: The study included 21 patients with ischemic heart disease (HD) or valvular HD (16 men, 5 women, average age 69 years) with left ventricle (LV) dysfunction after cardiac surgery. Patients with biventricular (BIV) (CO 6.7 ± 1.7 L/min, CI 3.5 ± 0.8 L/min/m2) and LV (CO 6.2 ± 1.5 L/min, CI 3.2 ± 0.7 L/min/m2) pacing had statistically significantly higher CO and CI than patients with right ventricular (RV) (CO 5.4 ± 1.4 L/min, CI 2.8 ± 0.6 L/min/m2) pacing (BIV vs RV P ≤ 0.001; LV vs RV P ≤ 0.05; BIV vs LV P ≤ 0.05). Conclusions: RT3DE targeted and optimized CRT in the early postperative period after cardiac surgery provided better hemodynamic results than RV pacing. (PACE 2011; 34:1231–1240)

The outcome of the operation of the Ebstein anomaly in adulthood depends on the experience of the surgical team.We operated 38 adult patients with Ebstein anomaly at the age of 34.8 ± 12.7 (19-63) years at the Department of Cardiac Surgery, Hospital Na Homolce, Prague, in the period of 2005-2013. The majority of patients (71 %) had Ebstein anomaly type C or D. The 30-days postoperative mortality was 5.2 %. In the long-term follow-up 2 other patients died. Tricuspid valve repair was performed in 45 %, bioprosthesis was implanted in 53 %. Concomitant bi-directional cavo-pulmonary anastomosis was performed in 31.5 %, mitral valve repair in 8 %, closure of atrial communication in 83 %, right-sided MAZE or istmus cryo-ablation in 39 %. After the operation we found improvement of the functional NYHA class (from 2.2 ± 0.7 to 1.7 ± 0.6; p0.0001) as well as decrease of tricuspid regurgitation (from grade 3.8 ± 0.4 to 0.9 ± 1; p0.0001). The ejection fraction of the right ventricle (RVEF) improved in 86 % of patients, in 14 % RVEF decreased or did not change (RVEF before operation 36 ± 10.5 %, after operation 42 ± 9.5 %, p = 0.001). In the long-term follow-up we found dysfunction of the tricuspid valve repair in 12 % and degeneration of the bioprosthesis in 15 %. Among 86 adult patients with Ebstein anomaly from our database the mortality was significantly higher in unoperated compared to operated patients (26 % vs 12 %, p = 0.006). Patients with cyanosis had high mortality regardless of surgery (40 % with and 83 % without operation). Reoperation after surgery in childhood or adulthood was necessary in 20 % of adults.The adult patients with Ebstein anomaly should be examined in a specialized center even if the symptoms are mild. The operation should be performed by a team with good results and experience in surgery and post-operative care in Ebstein anomaly. According to our knowledge Hospital Na Homolce represents such specialized center for Czech Republic.

Double valve replacement for concomitant aortic and mitral valve disease is associated with substantial morbidity and mortality. Excellent results with valve repair in isolated mitral valve lesions have been reported; therefore, whether its potential benefits would translate into better outcomes in patients with combined mitral-aortic disease was investigated.A retrospective observational study was performed involving 341 patients who underwent aortic valve replacement with either mitral valve repair (n=42) or double valve replacement (n=299). Data were analyzed for early mortality, late valve-related complications and survival.The early mortality rate was 11.9% for valve repair and 11.0% for replacement (P=0.797). Survival (± SD) was 67±11% in mitral valve repair with aortic valve replacement and 81±3% in double valve replacement at five years of follow-up (P=0.187). The percentage of patients who did not experience major adverse valve-related events at five years of follow-up was 83±9% in those who underwent mitral valve repair with aortic valve replacement and 89±2% in patients who underwent double valve replacement (P=0.412). Age70 years (HR 2.4 [95% CI 1.1 to 4.9]; P=0.023) and renal dysfunction (HR 1.9 [95% CI 1.2 to 3.7]; P=0.01) were independent predictors of decreased survival.In patients with double valve disease, both mitral valve repair and replacement provided comparable early outcomes. There were no significant differences in valve-related reoperations, anticoagulation-related complications or prosthetic valve endocarditis. Patient-related factors appear to be the major determinant of late survival, irrespective of the type of operation.

A patient with dilated cardiomyopathy and no history of thromboembolic events received a surgically implanted axial-flow left ventricular assist device. After implantation, transesophageal echocardiography revealed a giant thrombus on the lateral and anterior aspects of the left ventricle. The inflow cannula inserted through the apex of the left ventricle was not obstructed, and the device generated satisfactory blood flow. Laboratory screening for thrombophilia showed protein S deficiency, heterozygous factor V Leiden mutation, and heterozygous MTHFR C667T mutation. During the entire duration of circulatory support, no significant suction events were detected, and the patient was listed for heart transplantation. Ventricular assist device implantation can unmask previously undiagnosed thrombophilia; therefore, it should be necessary to identify thrombophilic patients before cardiac support implantation.

Background: Aortic dissection in a cardiac allograft is an uncommon complication of heart transplantation with only few cases reported in the literature. Method: We report a case of 46-year-old female who underwent orthotopic heart transplantation for dilated cardiomyopathy 22 years earlier. During surveillance echocardiographic examination she was diagnosed with type A aortic dissection limited to the donor aorta. The aortic root was successfully replaced using a valve-sparing David procedure. The pathogenesis and surgical management of these dissections is reviewed. Conclusion: Appropriate surgical repair performed in a timely fashion leads to excellent results improving the prognosis of these patients. (J Card Surg 2012;27:125–127)

Intermittent dysfunction of prosthetic aortic valve is a rare but life-threatening condition that may be difficult to recognize. Here, we present a case of 64-year-old man with a history of bicuspid aortic valve that had been replaced with a Medtronic-Hall prosthesis 15 years earlier. Until his current illness, he was fit, with good function of the valve and well maintained anticoagulation. After several days of progressive intermittent breathlessness, he experienced severe anginal chest pain, orthopnea, and dizziness that proceeded into an electromechanical dissociation. Circulation was restored after a brief resuscitation, intubation, and the administration of vasopressors by emergency medical services personnel. On admission to the intensive care unit, he had sinus rhythm with intraventricular conduction defect (Figure 1), stable blood pressure on vasopressors, and was ventilated for pulmonary edema (Figure 2). Nongated chest computed tomography scan ruled out an aortic dissection, and no particular abnormality was observed in the area of …

Congestive heart failure negatively impacts the prognosis in patients after cardiac surgery. The aim of our study was to assess the value of targeted cardiac resynchronization therapy (CRT) within 72 hours after cardiac surgery in patients with mechanical dyssynchrony, who had an ejection fraction ≤ 35%, QRS ≥150 ms or between 120 and 150 ms.A prospective randomized trial based on three-dimensional echocardiography (RT3DE) and optimized sequential dual-chamber (DDD ) pacing in patients after cardiac surgery. DDD epicardial pacing (Medtronic coaxial epicardial leads 6495) was provided by a modified Medtronic INSYNC III Pacemaker (Medtronic Inc., Minneapolis, MN, USA).The study included 21 patients with ischemic heart disease (HD) or valvular HD (16 men, 5 women, average age 69 years) with left ventricle (LV) dysfunction after cardiac surgery . Patients with biventricular (BIV) (CO 6.7 ± 1.7 L/min, CI 3.5 ± 0.8 L/min/m(2) ) and LV (CO 6.2 ± 1.5 L/min, CI 3.2 ± 0.7 L/min/m(2) ) pacing had statistically significantly higher CO and CI than patients with right ventricular (RV) (CO 5.4 ± 1.4 L/min, CI 2.8 ± 0.6 L/min/m(2) ) pacing (BIV vs RV P ≤ 0.001; LV vs RV P ≤ 0.05; BIV vs LV P ≤ 0.05).RT3DE targeted and optimized CRT in the early postperative period after cardiac surgery provided better hemodynamic results than RV pacing.

Prevalence of terminal forms of heart failure is steadily increasing and thus waiting time for heart transplantation, too. Increasing mortality on waiting list has urged implementation of mechanical circulatory support as an adjunct to the programme of heart transplantation. The objective of the study is to review 7-years experience with paracorporeal assist device in bridging to transplantation.Retrospective review of 53 transplant candidates treated since April 2003. 50 patients received paracorporeal assist devices in biventricular configuration. Most frequent diagnosis was dilated cardiomyopathy in 51%.Despite a high risk profile of the patients, 37 of them were successfully transplanted (69.8%). Cumulative support has reached 3513 days. Local exit sites infection was identified as a most frequent complication, sepsis as a most frequent cause of death on support (18.8%). 30-days post-transplant mortality remained low at 5.7%.Paracorporeal mechanical circulatory assist devices remain effective alternative for terminal stage heart transplant candidates, especially for those in multiorgan failure who require biventricular support. Success rate of bridging to transplantation is acceptable, as well as complications rate and quality of life while on support. Long-term post-transplant survival is not inferior to the results of procedures performed without necessity of previous implantation of the assist device.

Severe aortic stenosis (AS) has a poor prognosis when associated with left ventricular dysfunction and congestive heart failure. Despite a relatively high operative mortality, most patients with severe AS and a depressed left ventricular ejection fraction (LVEF) should be considered candidates for aortic valve replacement. The CentriMag left ventricular assist system (Levitronix) can be used for perioperative or postcardiotomy circulatory support for the failing heart. In this case report, we report the successful use of the Levitronix CentriMag device as perioperative support in a high-risk patient with severe AS, significant mitral insufficiency, and a poor LVEF with advanced organ failure.

The surgical technique of simultaneous heart transplantation and aortic aneurysm repair has been reported previously. However, there is a subgroup of patients with end-stage cardiomyopathy requiring major aortic surgery who do not meet heart transplant criteria. The optimal treatment strategy for these patients is still to be defined. In this report, we describe the use of an implantable continuous-flow left ventricular assist device (LVAD) as an adjunct to extensive aortic repair for providing patients with an acceptable risk surgical alternative to palliative treatment. To the best of our knowledge, this is the first report of this approach in the published literature.

From the point of view of established practice, redundant permanent pacing leads have been abandoned or extracted using various catheter-based procedures. An unusual complication was caused by failed surgical lead extraction resulting in electrode severing and wire unbraiding with subsequent induction of electric interaction between the metallic, noninsulated part of the lead fragment and the defibrillating electrode. This interaction was sensed and detected by the ICD system. A modified catheter-based extraction procedure is described.

Objective: Some patients after myocardial infarction have an increased risk of malignant ventricular tachyarrhythmias (VTA) or sudden cardiac death. The aim of the study was to evaluate long-term results of surgical ablation of an arrhythmogenic substrate guided by simplified intraoperative mapping of pathological ventricular electrograms during sinus rhythm. Methods: The study population consisted of 77 patients (9 women; mean age 62.4 ^ 8.5 years) with previous Q-wave myocardial infarction and at least one documented episode of sustained VT/VF more than one month after the last infarction. The left ventricular ejection fraction was 31.3 ^ 8.8%. All but eight patients had clinical indication for concomitant coronary artery bypass surgery. All underwent preoperative electrophysiologic study. Intraoperative epicardial and endocardial mapping during sinus rhythm was performed using a multielectrode with 16 bipolar electrodes in combination with a multichannel recording system. Myocardial regions revealing fractionated, low amplitude signals lasting $ 130 ms were surgically excised or cryoablated. All surviving patients were restudied within one to two weeks after surgery using identical programmed electrical stimulation protocol. Results: Five (6.5%) patients died in the perioperative (30-days) period. In the remaining cohort, inducibility of any sustained VTA after surgical procedure was observed in 21 subjects (29.2%). An implantable cardioverter-defibrillator (ICD) was implanted in these patients. Recurrence of sustained VTA was documented during follow-up period in two patients who were noninducible after the surgery (at the month 10 and 22, respectively), and both received ICD as well. No patient died of sudden cardiac death. In 14 ICD patients, no significant VTA was documented during the mean follow-up of 37.3 ^ 23.2 months. Altogether, 61 from the 72 patients surviving the surgery (84.7%) remained free of spontaneous recurrences of VTA during the follow-up. Conclusions: Surgical ablation of an arrhythmogenic substrate guided by simplified intraoperative mapping in normothermic heart during sinus rhythm appears to be both safe and efficacious procedure that prevents recurrences of VTA in a substantial proportion of patients. q 2004 Elsevier B.V. All rights reserved.

Background. Left atrial surgical radiofrequency ablation represents an applicable and technically less demanding method for treating paroxysmal or permanent atrial fibrillation (AF) as a concomitant procedure. The aim of this study was to review the long-term outcomes of radiofrequency linear ablation for the treatment of AF limited to the left atrium in 3 groups of patients undergoing cardiac surgery.Methods. The study population consisted of 357 consecutive patients, who were divided into 3 groups on the basis of the underlying disease: group I, 126 patients with nonischemic mitral valve disease; group II, 164 patients with coronary artery disease and aortic and/or ischemic mitral valve disease or who underwent other concomitant procedures; and group III, 67 patients with coronary artery disease only.Results. Follow-up times were between 6 and 48 months (mean, 28.3 + 9.4 months). The 30-day hospital mortality rate was 2.80% (10 patients). Total mortality during the follow-up period reached 4.48% (16 patients). At discharge, 66% of group I patients, 64% of group II patients, and 69% of group in patients were in sinus rhythm. After 24 months, 60% of group I patients, 75% of group II patients, and 67% of group III patients were in sinus rhythm. A subgroup analysis of the patients with permanent AF showed that only 54% of these patients in group I, 52% in group II, and 67% in group III had a restored sinus rhythm at 24 months. Subgroup analysis also revealed that only 6 (27%) of 22 patients with a left atrium diameter >60 mm maintained a sinus rhythm during long-term follow-up. Biatrial contraction was restored in 75% of the patients with a stable sinus rhythm after 6 months of follow-up. Seven patients (2%) with symptomatic postoperative recurrent atrial arrhythmias underwent subsequent catheter ablation.Conclusion. Left atrial surgical radiofrequency ablation represents an applicable and technically less demanding method for treating paroxysmal or permanent AF as a concomitant procedure. Our results demonstrate the feasibility of this procedure for paroxysmal and persistent AF, with minimal risks to the patient. For permanent AF, further investigation and extensive intervention are essential.