Results of a Modified Left Atrial Maze Procedure as a Combined Procedure

Abstract

Starting in November 1999, we performed a left atrial radiofrequency ablation procedure concomitantly to a variety of cardiac surgical procedures. By January 2001, this ablation procedure had been performed on 100 patients (age 65.7 ± 10.4 years, 53 % male, 47 % female, left atrium 51.0 ± 7.5 mm) suffering either from chronic or paroxysmal atrial fibrillation. Primary cardiac pathology was mitral valve disease in most cases (43), aortic valve disease (28) or coronary heart disease (27). After bilateral pulmonary veins isolation, an additional ablation line was directed from the left pulmonary veins to the mitral valve annulus (Thermaline® probe, Boston Scientific Corporation, USA). Finally, the left atrial appendage was resected. Surgical success was evaluated in the immediate postoperative course, 3 and 6 months postoperatively (ECG and echocardiography), and every year after that. Operative time was 229.7 ± 56.5 min, ablation time 18.8 ± 6.9 min. Follow-up is 95 % complete at the time of writing. Mean follow-up time was 7.3 months, ranging from 3 to 23 months. Success (sinus rhythm and atrial contraction) was proven in 72 out of 90 patients (80.0 %) (75.0 % mitral valve surgery, 84.0 % other cardiac surgery). The reported results support a broad spectrum of indications for this left atrial ablation procedure.

Key words

Atrial fibrillation - radiofrequency ablation - atrial fibrillation surgery

References

• 1 Wolf P A, Mitchell J B, Baker C S, Kannel W B, D’Agostino R B. Impact of atrial fibrillation on mortality, stroke, and medical costs.  Arch Intern Med. 1998;  158 (3) 229-234
• 2 Cox J L, Schuessler R B, Boineau J P. The surgical treatment of atrial fibrillation: I. Summary of the current concepts of the mechanisms of atrial flutter and atrial fibrillation.  J Thorac Cardiovasc Surg. 1991;  101 402-405
• 3 Cox J L. The surgical treatment of atrial fibrillation: IV. Surgical technique.  J Thorac Cardiovasc Surg. 1991;  101 584-592
• 4 Cox J L, Schuessler R B, D’Agostino H J. et al . The surgical treatment of atrial fibrillation: III. Development of a definitive surgical procedure.  J Thorac Cardiovasc Surg. 1991;  101 569-583
• 5 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.  J Thorac Cardiovasc Surg. 1995;  110 473-484
• 6 Itzumoto H, Kawazoe K, Kitahara H, Kamata J. Operative results after the Cox/Maze procedure combined with a mitral valve operation.  Ann Thorac Surg. 1998;  66 800-804
• 7 Isobe F, Kawashima Y. The outcome and indications of the Cox maze III procedure for chronic atrial fibrillation with mitral valve disease.  J Thorac Cardiovasc Surg. 1998;  116 220-227
• 8 Kosakai Y, Kawaguchi A T, Isobe F. et al . Cox maze procedure for chronic atrial fibrillation associated with mitral valve disease.  J Thorac Cardiovasc Surg. 1994;  108 1049-1055
• 9 Cox J L, Ad N, Palazzo T. et al . The maze-III procedure combined with valve surgery.  Semin Thorac Cardiovasc Surg. 2000;  12 53-55
• 10 Schaff H V, Dearani J A, Daly R C, Orszulak T A, Danielson G K. Cox-maze procedure for atrial fibrillation: Mayo Clinic Experience.  Semin Thorac Cardiovasc Surg. 2000;  12 30-37
• 11 McCarthy P M, Gillinov A M, Castle L, Chung M, Cosgrove D. The Cox-maze procedure: The Cleveland Clinic Experience.  Semin Thorac Cardiovasc Surg. 2000;  12 25-29
• 12 Chen M C, Guo B F, Chang J P, Yeh K H, Fu M. Radiofrequency and cryoablation of atrial fibrillation in patients undergoing valvular operations.  Ann Thorac Surg. 1998;  65 1666-1672
• 13 Melo J Q, Adragao P, Neves J. et al . Surgery for atrial fibrillation using intraoperative radiofrequency ablation.  Rev Port Cardiol. 1998;  17 377-379
• 14 Melo J Q, Adragao P, Neves J. et al . Electrosurgical treatment of atrial fibrillation with a new intraoperative radiofrequency ablation catheter.  Thorac Cardiovasc Surg. 1999;  47 370-372
• 15 Sueda T, Nagata H, Shikata H. et al . Simple left atrial procedure for chronic atrial fibrillation associated with mitral valve disease.  Ann Thorac Surg. 1996;  62 1796-1800
• 16 Haissaguerre M, Jais P, Shah D C. et al . Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins.  N Engl J Med. 1998;  339 659-666
• 17 Chen S A, Hsieh M H, Tai C T. et al . Initiation of atrial fibrillation by ectopic beats originating from the pulmonary veins.  Circulation. 1999;  100 1879-1886
• 18 Sueda T, Nagata H, Orihashi K. et al . Efficacy of a simple left atrial procedure for chronic atrial fibrillation in mitral valve operations.  Ann Thorac Surg. 1997;  63 1070-1075
• 19 Tsui S S, Grace A A, Ludman P F. et al . Maze 3 for atrial fibrillation: Two cuts too few?.  PACE. 1994;  17 2163-2166
• 20 Cox J L, Ad N. New surgical and catheter-based modifications of the maze procedure.  Semin Thorac Cardiovasc Surg. 2000;  12 68-73
• 21 Garg A, Finneran W, Mollerus M. et al . Right atrial compartmentalization using radiofrequency catheter ablation for management of patients with refractory atrial fibrillation.  J Cardiovasc Electrophysiol. 1999;  10 763-771
• 22 Feld G K, Birgersdotter-Green U, Fujimura O. et al . Radiofrequency catheter ablation of the right atrium for control of atrial fibrillation refractory to anti-arrhythmic drugs.  J Am Coll Cardiol. 1997;  29 176A