Off-pump epicardial high intensity focused ultrasound ablation of atrial fibrillation in patients undergoing structural heart repair.

There are a number of different devices and approaches to the management of atrial fibrillation (AF) coexisting in patients undergoing structural heart repair. Based on the widespread applicability and safety of an epicardial approach, the uniqueness of the energy source and the lesion set obtainable, we began a systematic program in 2005 utilizing high intensity focused ultrasound (HIFU). Our approach has been standardized in the operative and postoperative phases. Epicardial HIFU ablation performed concomitantly in patients undergoing other cardiac surgery has been performed over 300 times in the last 3 years at our institution. Over 90% of patients with AF complicating structural heart disease are offered an ablation in our practice. Freedom from AF has remained at over 80% in patients treated, with no additional risk to the patient resulting from the ablation procedure.