Objective: To assess results of atrial fibrillation (AF) ablation with a limited lesion set created with bipolar radiofrequency.
Methods: From 11/2001 to 10/2003, 211 patients with AF and structural heart disease (mitral valve dysfunction in 79%) had intraoperative ablation with a bipolar radiofrequency clamp. Median duration of preoperative AF was 24 months; AF was permanent in 51%, persistent in 23%, and paroxysmal in 25%. All patients had bilateral pulmonary vein isolation and excision/exclusion of the left atrial appendage.
Results: Mean ablation time was 18±7 minutes. Early postoperative AF occurred in 137 patients (65%; Figure) and was treated with antiarrhythmic medications and electrical cardioversion. At hospital discharge, 73% were free of AF; at last follow-up (median=3 months), 68% were free. Type of preoperative AF influenced results; at last follow-up, AF was absent in 81% of patients with a history of paroxysmal, 73% persistent, and 58% permanent AF. Among patients with EKGs obtained more than 6 months after surgery (n=79), 73% were free of AF, including 81% with history of paroxysmal, 82% persistent, and 57% permanent AF.
Conclusions: Bipolar radiofrequency facilitates rapid and safe AF ablation in patients undergoing surgery for structural heart disease. Perioperative AF is common and usually transient. A simple lesion set including pulmonary vein isolation is effective in paroxysmal and persistent AF; permanent AF requires a more extensive lesion set.

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