Left Atrial Radiofrequency Compartmentalization for Chronic Atrial Fibrillation during Heart Surgery

Introduction

Atrial fibrillation (AF) is the most common sustained clinical arrhythmia, and is associated with higher morbidity and mortality compared to the general population [1]. AF becomes increasingly common with age [2], and is responsible for substantial hospital costs. In patients with chronic AF and valvular disease, arrhythmia usually persists after successful surgical correction of the underlying pathology [3]. Besides restoration of sinus rhythm (SR), a curative surgical treatment of AF has to achieve normalization in the atrial hemodynamics and a decrease in thromboembolic risks without the need for systemic anticoagulation. After many years of experimental work on the Maze procedure, Cox et al. succeeded in developing a method of surgical treatment of AF which solves these problems [4]. The main principle of the Maze operation is the ablation of all potential re-entrant circuits by multiple atrial incisions. Several modifications have been developed to the original procedure ending-up in the so-called maze-III. Recently, Sueda [5] presented excellent results with an exclusive left atrial ablation in addition to mitral valve procedures. Melo [6] and Kottkamp [7] reduced the pattern to bilateral pulmonary vein isolation and ablation of anatomic re- entrant circuits by temperature controlled radiofrequency.

We therefore applied a new, simplified RF ablation approach to compartmentalize the left atrium as a modification of the Maze procedure. This was performed in addition to the primarily planned cardiac surgical interventions.

References

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