Vol. 23 No. 4 (2019)
REVIEWS

Contemporary use of surgical radiofrequency ablation and coronary artery bypass in patients with long-standing, persistent atrial fibrillation and coronary heart disease

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  • A. Kalybekova,
  • S. Rahmonov,
  • A. Chernyavskiy,
  • A. Almazov,
  • G. Narcissova,
  • S. Mironenko
A. Kalybekova
Meshalkin National Medical Research Center, Novosibirsk
Bio
S. Rahmonov
Meshalkin National Medical Research Center, Novosibirsk
A. Chernyavskiy
Meshalkin National Medical Research Center, Novosibirsk
A. Almazov
Central Clinical Hospital, Novosibirsk
G. Narcissova
Meshalkin National Medical Research Center, Novosibirsk
S. Mironenko
Meshalkin National Medical Research Center, Novosibirsk
DOI: https://doi.org/10.21688/1681-3472-2019-4-37-46

Published 2019-12-27

Keywords

  • atrial fibrillation,
  • biatrial ablation,
  • coronary heart disease,
  • left atrial ablation,
  • Maze-procedure,
  • radiofrequency ablation
    • ...More
    Less

How to Cite

Kalybekova, A., Rahmonov, S., Chernyavskiy, A., Almazov, A., Narcissova, G., & Mironenko, S. (2019). Contemporary use of surgical radiofrequency ablation and coronary artery bypass in patients with long-standing, persistent atrial fibrillation and coronary heart disease. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 23(4), 37–46. https://doi.org/10.21688/1681-3472-2019-4-37-46

Copyright (c) 2019 Kalybekova A. T., Rahmonov S. S., Chernyavskiy A. M., Almazov A. A., Narcissova G. P., Mironenko S. P.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

Atrial fibrillation is one of the main types of arrhythmia; it leads to deterioration in haemodynamics, a decrease in patient’s quality of life, the development of complications such as stroke, a decrease in tolerance to physical stress and ultimately death. The reported prevalence of atrial fibrillation among the general population is 0.4%–1%. The incidence of atrial fibrillation has been found to increase with age such that every 10-year increase in age doubles the incidence of this disease. The incidence of coronary heart disease also increases with age. Current studies have shown an increase in concomitant diseases such as coronary heart disease and atrial fibrillation; these pose a serious health threat and increase the risk of patient death. The present review discusses surgical methods for treating long-standing, persistent atrial fibrillation in patients with coronary heart disease based on radiofrequency and cryoablation with simultaneous coronary artery bypass grafting. The present review revealed that biatrial ablation allows achieving high levels of markers that indicate atrial fibrillation recurrence-free survival following simultaneous surgical correction of coronary heart disease in the long-term postoperative period; however, patients undergoing this procedure require permanent pacemaker implantation due to the high incidence of irreversible sinus node dysfunction caused by the exposure to additional ablation lines in the right atrium. Published articles were searched from January to July 2019 using PubMed, eLIBRARY, Elsevier and MEDLINE.

Received 9 July 2019. Revised 22 November 2019. Accepted 26 November 2019.

Funding: The study did not have sponsorship.

Conflict of interest: Authors declare no conflict of interest.

Author contributions
Conception and study design: A.T. Kalybekova
Drafting the article: A.T. Kalybekova, A.A. Almazov
Critical revision of the article: A.T. Kalybekova, S.S. Rahmonov
Final approval of the version to be published: A.T. Kalybekova, S.S. Rahmonov, A.M. Chernyavskiy, A.A. Almazov, G.P. Narcissova, S.P. Mironenko

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References

  1. Кушаковский М.С. Фибрилляция предсердий. СПб: Фолиант, 1999. 175 с. [Kushakovskij M.S. Atrial fibrillation. Saint Petersburg: Foliant, 1999. 175 p.]
  2. Marinigh R., Lip G.Y., Fiotti N., Giansante C., Lane D.A. Age as a risk factor for stroke in atrial fibrillation patients: implications for thromboprophylaxis. J Am Coll Cardiol. 2010;56(11):827-37. PMID: 20813280. https://doi.org/10.1016/j.jacc.2010.05.028
  3. Бойцов С.А. Механизмы снижения смертности от ишемической болезни сердца в разных странах мира. Профилактическая медицина. 2013;16(5):9-19. Режим доступа: https://www.mediasphera.ru/issues/profilakticheskaya-meditsina/2013/5/031726-6130201352 [Boitsov SA. Mechanisms of reduction in coronary heart disease mortality in different countries of the world. Russian Journal of Preventive Medicine and Public Health = Profilakticheskaya meditsina. 2013;16(5):9-19. (In Russ.) Available from: https://www.mediasphera.ru/issues/profilakticheskaya-meditsina/2013/5/031726-6130201352/annotation]
  4. Миллер О.Н., Белялов Ф.И. Фибрилляция предсердий. Тактика ведения пациентов на догоспитальном, стационарном и амбулаторном этапах. Российский кардиологический журнал. 2009;(4):94-111. https://doi.org/10.15829/1560-4071-2009-4-94-111 [Miller O.N., Belyalov F.I. Atrial fibrillation: pre-hospital, hospital, and ambulatory management tactics. Russian Journal of Cardiology. 2009;(4):94-111. (In Russ.) https://doi.org/10.15829/1560-4071-2009-4-94-111]
  5. Jabre P., Jouven X., Adnet F., Thabut G., Bielinski S.J., Weston S.A., Roger V.L. Atrial fibrillation and death after myocardial infarction: a community study. Circulation. 2011;123(19):2094-100.
  6. Brüggenjürgen B., Rossnagel K., Roll S., Andersson F.L., Selim D., Müller-Nordhorn J., Nolte C.H., Jungehülsing G.J., Villringer A., Willich S.N. The impact of atrial fibrillation on the cost of stroke: the berlin acute stroke study. Value Health. 2007;10(2):137-43. PMID: 17391422. https://doi.org/10.1111/j.1524-4733.2006.00160.x
  7. Шмуль А.В., Ревишвили А.Ш., Сергуладзе С.Ю., Кваша Б.И., Такаландзе Р.Г. Результаты хирургического лечения персистирующей и длительно существующей персистирующей формы фибрилляции предсердий с использованием эпикардиальной биполярной радиочастотной аблации. Бюллетень НЦССХ им. А.Н. Бакулева РАМН. Сердечно-сосудистые заболевания. 2013;14(S6):87. [Shmul A.V., Revishvili A.SH., Serguladze S.Yu., Kvasha B.I., Takalandze R.G. Surgical treatment results of persistant and long-standing persistant atrial fibrillation, with using epicardial bipolar radiofrequency ablation. Cardiovascular diseases. 2013;14(S6):87]
  8. Neale T. Dabigatran reversal agent’s safety, efficacy affirmed with updated study results. tctMD/ the heart beat. Режим доступа: https://www.tctmd.com/news/dabigatran-reversal-agents-safety-efficacy-affirmed-updated-study-results [Neale T. Dabigatran reversal agent’s safety, efficacy affirmed with updated study results. tctMD/ the heart beat. Available from: https://www.tctmd.com/news/dabigatran-reversal-agents-safety-efficacy-affirmed-updated-study-results]
  9. Cox J.L., Boineau J.P., Schuessler R.B., Kater K.M., Ferguson T.B. Jr., Cain M.E., Lindsay B.D., Smith J.M., Corr P.B., Hogue C.B., et al. Electrophysiologic basis urgical development, and clinical results of the maze procedure for atrial flutter and atrial fibrillation. Adv Card Surg. 1995;6:1-67. PMID: 7894763.
  10. Cox J.L. The surgical treatment of atrial fibrillation. IV. Surgical technique. J Thorac Cardiovasc Surg. 1991;101(4):584-92. PMID: 2008096.
  11. Cox J.L., Boineau J.P., Schuessler R.B., Jaquiss R.D., Lappas D.G. Modification of the maze procedure for atrial flutter and atrial fibrillation. I. Rationale and surgical results. J Thorac Cardiovasc Surg. 1995;110(2):473-84. PMID: 7637365. https://doi.org/10.1016/S0022-5223(95)70244-X
  12. Akbarzadeh F., Parvizi R., Safaie N., Karbalaei M.M., Hazhir-Karzar B., Bagheri B. Freedom from atrial fibrillation after cox maze III ablation during follow-up. Niger Med J. 2015;56(1):59-63. PMCID: PMC4314862, PMID: 25657496. https://doi.org/10.4103/0300-1652.149173
  13. Gomes G.G., Gali W.L., Sarabanda A.V.L., Cunha C.R.D., Kessler I.M., Atik F.A. Late Results of Cox Maze III Procedure in Patients with Atrial Fibrillation Associated with Structural Heart Disease. Arq Bras Cardiol. 2017;109(1):14-22. PMCID: PMC5524471, PMID: 28678926. https://doi.org/10.5935/abc.20170082
  14. Kirchhof P., Benussi S., Kotecha D., Ahlsson A., Atar D., Casadei B., Castella M., Diener H.C., Heidbuchel H., Hendriks J., Hindricks G., Manolis A.S., Oldgren J., Popescu B.A., Schotten U., Van Putte B., Vardas P., Agewall S., Camm J., Baron Esquivias G., Budts W., Carerj S., Casselman F., Coca A., De Caterina R., Deftereos S., Dobrev D., Ferro J.M., Filippatos G., Fitzsimons D., Gorenek B., Guenoun M., Hohnloser S.H., Kolh P., Lip G.Y., Manolis A., McMurray J., Ponikowski P., Rosenhek R., Ruschitzka F., Savelieva I., Sharma S., Suwalski P., Tamargo J.L., Taylor C.J., Van Gelder I.C., Voors A.A., Windecker S., Zamorano J.L., Zeppenfeld K. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace. 2016;18(11):1609-78. PMID: 27567465. https://doi.org/10.1093/europace/euw295
  15. Badhwar V., Rankin J.S., Damiano R.J. Jr, Gillinov A.M., Bakaeen F.G., Edgerton J.R., Philpott J.M., McCarthy P.M., Bolling S.F., Roberts H.G., Thourani V.H., Suri R.M., Shemin R.J., Firestone S., Ad N. The Society of Thoracic Surgeons 2017 Clinical Practice Guidelines for the Surgical Treatment of Atrial Fibrillation. Ann Thor Surg. 2017;103:329-41. PMID: 28007240. https://doi.org/10.1016/j.athoracsur.2016.10.076
  16. Kik C., Bogers A.J.J.C. Maze Procedures for Atrial Fibrillation, From History to Practice. Cardiol Res. 2011;2(5):201-207. PMCID: PMC5358279, PMID: 28357007. https://doi.org/10.4021/cr79w
  17. Cheng D.C., Ad N., Martin J., Berglin E.E., Chang B.C., Doukas G., Gammie J.S., Nitta T., Wolf R.K., Puskas J.D. Surgical ablation for atrial fibrillation in cardiac surgery: a meta-analysis and systematic review. Innovations (Phila). 2010;5(2):84-96. PMID: 22437354. https://doi.org/10.1097/IMI.0b013e3181d9199b
  18. Barnett S.D., Ad N. Surgical ablation as treatment for the elimination of atrial fibrillation: a meta-analysis. J Thorac Cardiovasc Surg. 2006;131(5):1029-35. PMID: 16678586. https://doi.org/10.1016/j.jtcvs.2005.10.020
  19. Blomström-Lundqvist C., Johansson B., Berglin E., Nilsson L., Jensen S.M., Thelin S., Holmgren A., Edvardsson N., Källner G., Blomström P. A randomized double-blind study of epicardial left atrial cryoablation for permanent atrial fibrillation in patients undergoing mitral valve surgery: the SWEDish Multicentre Atrial Fibrillation study (SWEDMAF). Euro Heart J. 2007;28(23):2902-8. PMID: 17984136. https://doi.org/10.1093/eurheartj/ehm378
  20. Ad N., Henry L., Hunt S., Holmes S.D. Do we increase the operative risk by adding the Cox Maze III procedure to aortic valve replacement and coronary artery bypass surgery? J Thorac Cardiovasc Surg. 2012;143(4):936-44. https://doi.org/10.1016/j.jtcvs.2011.12.018
  21. Mohr F.W., Fabricius A.M., Falk V., Autschbach R., Doll N., Von Oppell U., Diegeler A., Kottkamp H., Hindricks G. Curative treatment of atrial fibrillation with intraoperative radiofrequency ablation: short-term and midterm results. J Thorac Cardiovasc Surg. 2002;123:919-27. PMID: 12019377. https://doi.org/10.1067/mtc.2002.120730
  22. Moten S.C., Rodriguez E., Cook R.C., Nifong L.W., Chitwood W.R. Jr. New ablation techniques for atrial fibrillation and the minimally invasive cryo-maze procedure in patients with lone atrial fibrillation. Heart Lung Circ. 2007;16(Suppl 3):S88-93. PMID: 17611154. https://doi.org/10.1016/j.hlc.2007.05.005
  23. Khargi K., Keyhan-Falsafi A., Hutten B.A., Ramanna H., Lemke B., Deneke T. Surgical treatment of atrial fibrillation: a systematic review. Herzschrittmacherther Elektrophysiol. 2007;18(2):68-76. PMID: 17646938. https://doi.org/10.1007/s00399-007-0562-0
  24. Pecha S., Schäfer T., Yildirim Y., Ahmadzade T., Willems S., Reichenspurner H., Wagner F.M. Predictors for permanent pacemaker implantation after concomitant surgical ablation for atrial fibrillation. J Thorac Cardiovasc Surg. 2014;147(3):984-8. PMID: 23566511. https://doi.org/10.1016/j.jtcvs.2013.03.012
  25. Henn M.C., Lancaster T.S., Miller J.R., Sinn L.A., Schuessler R.B., Moon M.R., Melby S.J., Maniar H.S., Damiano R.J. Jr. Late outcomes after the Cox maze IV procedure for atrial fibrillation. J Thorac Cardiovasc Surg. 2015;150(5):1168–1176, 1178.e1161-1162. PMID: 26432719, PMCID: PMC4637220. https://doi.org/10.1016/j.jtcvs.2015.07.102
  26. Gillinov A.M., Gelijns A.C., Parides M.K., DeRose J.J. Jr., Moskowitz A.J., Voisine P., Ailawadi G., Bouchard D., Mack M.J., Acker M.A., Mullen J.C., Rose E.A., Chang H.L., Puskas J.D., Couderc J.P., Gardner T.J., Varghese R., Horvath K.A., Bolling S.F., Michler R.E., Geller N.L., Ascheim D.D.,.Miller M.A., Bagiella E., Moquete E.G., Williams P., Taddei-Peters W.C., O'Gara P.T., Blackstone E.H., Argenziano M.; CTSN Investigators. Surgical ablation of atrial fibrillation during mitral-valve surgery. N Engl J Med. 2015;372(15):1399-409. PMID: 25853744, PMCID: PMC4664179. https://doi.org/10.1056/NEJMoa1500528
  27. Wang J., Meng X., Li H., Cui Y., Han J., Xu C. Prospective randomized comparison of left atrial and biatrial radiofrequency ablation in the treatment of atrial fibrillation. Eur J Cardiothorac Surg. 2009;35(1):116-22. PMID: 18952450. https://doi.org/10.1016/j.ejcts.2008.09.014
  28. Barnett S.D., Ad N. Surgical ablation as treatment for the elimination of atrial fibrillation: a meta-analysis. J Thorac Cardiovasc Surg. 2006;131(5):1029-35. PMID: 16678586. https://doi.org/10.1016/j.jtcvs.2005.10.020
  29. Gillinov A.M., Bhavani S., Blackstone E.H., Rajeswaran J., Svensson L.G., Navia J.L., Pettersson B.G., Sabik J.F. 3rd, Smedira N.G., Mihaljevic T., McCarthy P.M., Shewchik J., Natale A. Surgery for permanent atrial fibrillation: impact of patient factors and lesion set. Ann Thorac Surg. 2006;82(2):502-13; discussion 513-4. PMID: 16863753. https://doi.org/10.1016/j.athoracsur.2006.02.030
  30. Onorati F., Mariscalco G., Rubino A.S., Serraino F., Santini F., Musazzi A., Klersy C., Sala A., Renzulli A. Impact of lesion sets on mid-term results of surgical ablation procedure for atrial fibrillation. J Am Coll Cardiol. 2011;57(8):931-40. PMID: 21329840. https://doi.org/10.1016/j.jacc.2010.09.055
  31. Soni L.K., Cedola S.R., Cogan J., Jiang J., Yang J., Takayama H., Argenziano M. Right atrial lesions do not improve the efficacy of a complete left atrial lesion set in the surgical treatment of atrial fibrillation, but they do increase procedural morbidity. J Thorac Cardiovasc Surg. 2013;145(2):356-61; discussion 361-3. https://doi.org/10.1016/j.jtcvs.2012.09.091
  32. Ad N., Holmes S.D., Lamont D., Shuman D.J. Left-sided surgical ablation for patients with atrial fibrillation who are undergoing concomitant cardiac surgical procedures. Ann Thorac Surg. 2017;103(1):58-65. PMID: 27544292. https://doi.org/10.1016/j.athoracsur.2016.05.093
  33. Meng Z., Dong J., and Jiang F. Biatrial ablation versus left atrial ablation with bipolar system in the surgical treatment of atrial fibrillation with mitral valve disease. Chinese Journal of Thoracic and Cardiovascular Surgery. 2014;30:482-5.
  34. Phan K., Xie A., Tsai Y.C., Kumar N., La Meir M., Yan T.D. Biatrial ablation vs. left atrial concomitant surgical ablation for treatment of atrial fibrillation: a meta-analysis. Europace. 2015;17(1):38-47. PMID: 25336669. https://doi.org/10.1093/europace/euu220
  35. Богачев-Прокофьев А.В., Емешкин М.И., Афанасьев А.В., Пивкин А.Н., Шарифулин Р.М., Железнев С.И., Овчаров А.М., Караськов А.М. Сравнительный анализ потребности в имплантации кардиостимулятора при левопредсердной и биатриальной конкомитантной аблации у пациентов с клапанными пороками сердца. Анналы аритмологии 2018;15(1):24-32. https://doi.org/10.15275/annaritmol.2018.1.3 [Bogachev-Prokof'ev A.V., Emeshkin M.I., Afanas'ev A.V., Pivkin A.N., Sharifulin R.M., Zheleznev S.I., Ovcharov M.A., Karas'kov A.M. Comparative analysis of the requirement for pacemaker implantation in the left atrial and biatrial concomitant ablation in patients with valvular heart disease. Annals of Arrhythmology. 2018;15(1):24-32. https://doi.org/10.15275/annaritmol.2018.1.3]
  36. Phan K., Xie A., Tsai Y.C., Kumar N., La Meir M., Yan T.D. Biatrial ablation vs. left atrial concomitant surgical ablation for treatment of atrial fibrillation: a meta-analysis. Europace 2015;17(1):38-47. PMID: 25336669. https://doi.org/10.1093/europace/euu220
  37. Емешкин М.И., Богачев-Прокофьев А.В., Афанасьев А.В., Шарифулин Р.М., Овчаров А.М., Караськов А.М. Сравнительная эффективность биатриальной и левопредсердной конкомитантной хирургической аблации в лечении фибрилляции предсердий. Кардиология и сердечно-сосудистая хирургия. 2018:11(5):6-14. Режим доступа: https://mediasphera.ru/issues/kardiologiya-i-serdechno-sosudistaya-khirurgiya/2018/5/1199663852018051006 [Emeshkin M.I., Bogachev-Prokofev A.V., Afanasev A.V., Sharifulin R.M., Ovcharov A.M., Karaskov A.M. Comparative efficacy of biatrial and left atrial surgical treatment of atrial fibrillation. Russian Journal of Cardiology and Cardiovascular Surgery = Kardiologiya i serdechno-sosudistaya khirurgiya. 2018:11(5):6-14. (In Russ.) Available from: https://mediasphera.ru/issues/kardiologiya-i-serdechno-sosudistaya-khirurgiya/2018/5/1199663852018051006]
  38. Чернявский А.М., Карева Ю.Е., Пак И.А., Рахмонов С.С., Покушалов Е.А., Романов А.Б. Опыт радиочастотной аблации фибрилляции предсердий в сочетании с коронарным шунтированием у больных ишемической болезнью сердца. Анналы аритмологии. 2011;8(2):30-35. Режим доступа: http://www.arrhythmology.pro/2011-2-030-035 [Chernyavsky A.M., Kareva Yu.E., Pak I.A., Rakhmonov S.S., Pokushalov E.A., Romanov A.B. Experience of radiofrequency ablation of atrial fibrillation combined with coronary artery bypass grafting in patients with ischemic heart disease. Annals of Arrhythmology. 2011;8(2):30-35. (In Russ.) Available from: http://www.arrhythmology.pro/2011-2-030-035]
  39. Чернявский А.М., Рахмонов С.С., Пак И.А., Карева Ю.Е. Результаты хирургического лечения фибрилляции предсердий методом эпикардиальной радиочастотной аблации анатомических зон ганглионарных сплетений левого предсердия во время аортокоронарного шунтирования. Патология кровообращения и кардиохирургия. 2013;17(2):57-61. http://dx.doi.org/10.21688/1681-3472-2013-2-57-61 [Chernyavskiy A.M., Rakhmonov S.S., Kareva Yu.Ye., Pak I.A. The results of treatment of atrial fibrillation with method of epicardial radiofrequency ablation of anatomic zones ganglionic plexi of the left atrium during CABG. Patologiya krovoobrashcheniya i kardiokhirurgiya = Circulation Pathology and Cardiac Surgery. 2013;17(2):57-61. (In Russ.). http://dx.doi.org/10.21688/1681-3472-2013-2-57-61]
  40. Чернявский А.М., Карева Ю.Е., Пак И.А., Рахмонов С.С., Романов А.Б., Покушалов Е.А. Комплексная оценка результатов хирургического лечения персистирующей фибрилляции предсердий во время операции аортокоронарного шунтирования. Вестник аритмологии. 2013;71:35-44. Режим доступа: http://www.vestar.ru/atts/11372/vestar_71.pdf [Chernyavsky A.M., Kareva Yu.E., Pak I.A., Rakhmonov S.S., Romanov A.B., Pokushalov E.A. Complex assessment of outcomes of surgical treatment of persistent atrial fibrillation during aortocoronary bypass grafting surgery. 2013;71:35-44. (In Russ.) Available from: http://www.vestar.ru/atts/11372/vestar_71.pdf]
  41. Li H., Lin X., Ma X., Tao J., Zou R., Yang S., Liu H., Hua P. Biatrial versus isolated left atrial ablation in atrial fibrillation: a systematic review and meta-analysis. BioMed Res Int. 2018;2018;3651212. PMCID: PMC5949196, PMID: 29854748.
  42. Zheng S., Zhang H., Li Y., Han J., Jia Y., Meng X. Comparison of left atrial and biatrial maze procedure in the treatment of atrial fibrillation: a meta-analysis of clinical studies. Thorac Cardiovasc Surg. 2016;64(8):661-71. PMID: 26220695. http://dx.doi.org/10.1055/s-0035-1554941
  43. Liu H., Chen L., Xiao Y., Ma R., Hao J., Chen B., Qin C., Cheng W. Early efficacy analysis of biatrial ablation versus left and simplified right atrial ablation for atrial fibrillation treatment in patients with rheumatic heart disease. Heart, Lung and Circulation. 2015;24(8);789-95. PMID: 25766663. http://dx.doi.org/10.1016/j.hlc.2015.02.003
  44. Kim J.B., Bang J.H., Jung S.H., Choo S.J., Chung C.H., Lee J.W. Left atrial ablation versus biatrial ablation in the surgical treatment of atrial fibrillation. Ann Thoracic surgery. 2011;92(4):1397-405. PMID: 21958788. http://dx.doi.org/10.1016/j.athoracsur.2011.05.066
  45. Calo L., Lamberti F., Loricchio M.L., De Ruvo E., Colivicchi F., Bianconi L., Pandozi C., Santini M. Left atrial ablation versus biatrial ablation for persistent and permanent atrial fibrillation. A prospective and randomized study. J Am Coll Cardiol. 2006;47(12):2504-12. PMID: 16781381. http://dx.doi.org/10.1016/j.jacc.2006.02.047
  46. Albåge A., Péterffy M., Källner G. The biatrial cryo-maze procedure for treatment of atrial fibrillation: a single-center experience. Scand Cardiovasc J. 2011;45(2):112-9. PMID: 21275571. http://dx.doi.org/10.3109/14017431.2010.547595.
  47. Gualis J., Castaño M., Martínez-Comendador J.M., Marcos J.M., Martín C., Estévez-Loureiro R., Gómez-Plana J., Martín E., Otero J. [Biatrial vs. isolated left atrial cryoablation for the treatment of long-lasting permanent atrial fibrillation. Midterm recurrence rate]. Arch Cardiol Mex. 2016;86(2):123-9. PMID: 26549153. http://dx.doi.org/10.1016/j.acmx.2015.09.005