Initial experience with the maze procedure for atrial fibrillation

Left Atrial–Esophageal Fistula Following Radiofrequency Catheter Ablation of Atrial Fibrillation

“…Two other fatalities after RF surgical ablation have been reported. 8,9 Gillinov et al 8 related the complication to a very thin left atrium in a slim patient. Sonmez et al 9 suspected that overlapping of both circumferential lines on the left posterior wall that might have propitiated to left atrial-esophageal fistula in their patient.…”

“…8,9 Gillinov et al 8 related the complication to a very thin left atrium in a slim patient. Sonmez et al 9 suspected that overlapping of both circumferential lines on the left posterior wall that might have propitiated to left atrial-esophageal fistula in their patient. However, Doll et al 6 did not find any specific predictor for atrial-esophageal fistula in 4 of 387 patients undergoing RF surgical ablation.…”

“…Excessive body fluid retention was the most likely reason for this symptom; it has been observed in 12% to 36% of patients undergoing the maze procedure. 9,10 Recent reports have shown perioperative increases in arginine-vasopressin and aldosterone after the maze procedure and indicate that they, rather atrial natriuretic peptide alone, also participate in excessive postoperative fluid retention after the procedure. 11,12 This complication had not been described after RF catheter ablation, but a temporary lack of response of atrial baroreceptors 13 could be a strong stimulus for fluid retention after extensive catheter atrial ablation.…”

Video‐Assisted Thoracoscopy to Treat Atrial Tachycardia Arising from Left Atrial Appendage

“…Some investigators have identified significant postoperative fluid retention 11,12 or reduced sodium secretion 13 in patients after surgery, including atrial appendectomy. Our patient underwent left atrial appendectomy due to tachycardia‐induced cardiomyopathy that proceeded to heart failure.…”

Optimized Technical and Electrophysiological Approach for Treatment of Atrial Fibrillation

“…The relative complexity and increased risk of morbidity in the maze procedure [McCarthy 1993;Jatene 1995;Kawaguchi 1996] has motivated surgeons to prefer procedures restricted only to the left atrium with ultrasound [Brick 1999] or radiofrequency [Wanderley 2003] application, reducing sections and sutures in the atrial walls with 70% to 80% efficacy in conversion of atrial fibrillation to regular atrial rhythm. In 6 cases of the present study, electrocautery was used as defined by Bath [2000], taking special care to keep a margin of at least 5 mm around each pulmonary vein ostium to avoid postoperative scar stenosis [Robbins 1998].…”