Surgical Treatment of Atrial Fibrillation.

Abstract

Atrial fibrillation (AF) is now commonly treated at the time of valvular heart surgery or coronary artery bypass grafting. Surgical ablation of AF, which is predicated upon the Maze procedure, includes creation of lines of conduction block and excision of the left atrial appendage. A full bi-atrial lesion set is associated with success in 80% to 95% of patients and virtually eliminates the risk of late stroke. A complex but safe operation, the classic cut-and-sew Maze procedure has been applied by relatively few surgeons. However, recent advances in understanding of the pathogenesis of AF and development of new ablation technologies enable surgeons to perform pulmonary vein isolation, create linear left and right atrial lesions, and remove the left atrial appendage rapidly and safely. Lesions are created under direct vision, minimizing the risk of damage to the pulmonary veins and adjacent mediastinal structures. Recently developed instrumentation now enables thoracoscopic and keyhole approaches, facilitating extension of epicardial AF ablation and excision of the left atrial appendage to patients with isolated AF and no other indication for cardiac surgery. In addition, novel devices designed specifically for minimally invasive epicardial exclusion of the left atrial appendage will broaden the range of treatment options for patients with AF, possibly eliminating the need for anticoagulation in selected patients.

Early outcomes of usage of cryoFORM® probe for cryomaze procedure in congenital heart surgery

“…Maze procedure is the gold standard surgical treatment of AF. 11 The original Cox-Maze I procedure was developed and modified to maze II, III by Dr Cox. 12 With the introduction of new energy sources that decreases the procedure time and lower the bleeding complications, it has started to be called the Maze IV procedure.…”

“…Maze procedure can be performed using energy sources such as RF, microwave, ultrasound, cryothermia, and laser, other than using a scalpel. 11 In the literature, there are publications presenting early and late-term outcomes of application of either different types of energy sources and "cut and sew technique" for the maze procedure. In the study of Giamberti et al, an RF ablation catheter was used for 80 congenital heart diseased adult patients, freedom from arrhythmic events at 1 and 5 years of follow-up was, respectively, 88 and 75% for those who underwent right-sided maze procedure, and 82 and 77% for those who received a Cox-Maze III.…”