Experience with Various Surgical Options for the Treatment of Atrial Fibrillation
Background: New alternatives exist using various energy sources and lesion lines for the surgical treatment of atrial fibrillation (AF). The efficacy of these options compared to the cut-and-sew maze III procedure is unknown.
Methods: From August 1996 to August 2003, 79 patients have undergone a procedure for AF, with 70 patients currently more than 3 months postsurgery. The patients (58 continuous, 12 paroxysmal) underwent a surgical procedure for AF, lone AF (12) and with concomitant procedures (58). Techniques included cut and sew (23), bipolar radiofrequency (RF) (28) and unipolar-RF (10), and cryothermy (9). Lesions included maze III (46), pulmonary vein isolation (16), and pulmonary vein isolation plus mitral annular connecting line only (8).
Results: Follow-up was complete in 58 (83%) of 70 patients at a mean time of 595 ± 750 days (range, 24-2530 days). The operative mortality was 0% in lone AF patients and 7.1% (5/70) in patients undergoing concomitant procedures. Need for perioperative pacemaker was 22.9%. Overall, normal sinus rhythm (NSR) was restored in 82.7% of patients, with success in 83.3% (10/12) lone procedures and 82.6% (38/46) concomitant procedures (P = NS); the rate of continuous AF was 85.1% (40/47) and SR with paroxysmal fibrillation was 72.7% (8/11) (P = NS). Traditional maze was successful in 80.6% (29/36) patients, pulmonary vein isolation was successful 93.3% (14/15), and left-sided maze in 71.4% (5/7) (P = NS). Cut and sew procedures were successful in 88.2% (15/17), RF-bipolar in 84.0% (21/25), RF-unipolar in 77.8% (7/9), and cryothermy in 71.4% (5/7) (P = NS). Energy source, lesion set, AF duration, and lone/concomitant procedure were the factors subjected to logistic regression analysis. No factors were predictive of achieving postoperative NSR. Conclusions: Our early experience with newer surgical techniques employing different energy sources and fewer incision lines suggests that the success rate may approach the results obtained with traditional cut-and-sew Cox-maze III procedures.
Wattigney WA, Mensah GA, Croft JB. 2003. Increasing trends in hospitalization for atrial fibrillation in the United States, 1985 through 1999: implications for primary prevention. Circulation 108:711-6.nDamiano RJ Jr, Gaynor SL, Bailey M, et al. 2003. The long-term outcome of patients with coronary disease and atrial fibrillation undergoing the cox maze procedure. J Thorac Cardiovasc Surg 126:2016-21.nDoll N, Kiaii BB, Fabricius AM, et al. 2003. Intraoperative left atrial ablation (for atrial fibrillation) using a new argon cryocatheter: early clinical experience. Ann Thorac Surg 76:1711-5.nFriberg J, Buch P, Scharling H, Gadsbphioll N, Jensen GB. 2003. Rising rates of hospital admissions for atrial fibrillation. Epidemiology 14:666-72.nPrasad SM, Maniar HS, Camillo CJ, et al. 2003. The Cox maze III procedure for atrial fibrillation: long-term efficacy in patients undergoing lone versus concomitant procedures. J Thorac Cardiovasc Surg 126:1822-7.nRaman JS, Ishikawa S, Power JM. 2002. Epicardial radiofrequency ablation of both atria in the treatment of atrial fibrillation: experience in patients. Ann Thorac Surg 74:1506-9.nTsang TS, Petty GW, Barnes ME, et al. 2003. The prevalence of atrial fibrillation in incident stroke cases and matched population controls in Rochester, Minnesota: changes over three decades. J Am Coll Cardiol 42:93-100.nCox JL. 2003. Atrial fibrillation, II: rationale for surgical treatment. J Thorac Cardiovasc Surg 126:1693-9.nCox JL. 2003. Atrial fibrillation, I: a new classification system. J Thorac Cardiovasc Surg 126:1686-92.nCox JL, Boineau JP, Schuessler RB, Kater KM, Lappas DG. 1993. Five-year experience with the maze procedure for atrial fibrillation. Ann Thorac Surg 56:814-23.nCox JL, Jaquiss RDB, Schuessler RB, Boineau JP. 1995. Modification of the maze procedure for atrial flutter and atrial fibrillation, II: surgical technique of the maze III procedure. J Thorac Cardiovasc Surg 110:485-95.n
How to Cite
Author Disclosure & Copyright Transfer Agreement
In order to publish the original work of another person(s), The Heart Surgery Forum® must receive an acknowledgment of the Author Agreement and Copyright Transfer Statement transferring to Forum Multimedia Publishing, L.L.C., a subsidiary of Carden Jennings Publishing Co., Ltd. the exclusive rights to print and distribute the author(s) work in all media forms. Failure to check Copyright Transfer agreement box below will delay publication of the manuscript.
A current form follows:
The author(s) hereby transfer(s), assign(s), or otherwise convey(s) all copyright ownership of the manuscript submitted to Forum Multimedia Publishing, LLC (Publisher). The copyright transfer covers the exclusive rights to reproduce and distribute the article and the material contained therein throughout the world in all languages and in all media of expression now known or later developed, including but not limited to reprints, photographic reproduction, microfilm, electronic data processing (including programming, storage, and transmission to other electronic data record(s), or any other reproductions of similar nature), and translations.
However, Publisher grants back to the author(s) the following:
- The right to make and distribute copies of all or part of this work for use of the author(s) in teaching;
- The right to use, after publication in The Heart Surgery Forum, all or part of the material from this work in a book by the author(s), or in a collection of work by the author(s);
- The royalty-free right to make copies of this work for internal distribution within the institution/company that employs the author(s) subject to the provisions below for a work-made-for-hire;
- The right to use figures and tables from this work, and up to 250 words of text, for any purpose;
- The right to make oral presentations of material from this work.
Publisher reserves the right to grant or refuse permission to third parties to republish all or part of the article or translations thereof. To republish, such third parties must obtain written permission from the Publisher. (This is in accordance with the Copyright Statute, United States Code, Title 17. Exception: If all authors were bona fide officers or employees of the U.S. Government at the time the paper was prepared, the work is a “work of the US Government” (prepared by an officer or employee of the US Government as part of official duties), and therefore is not subject to US copyright; such exception should be indicated on signature lines. If this work was prepared under US Government contract or grant, the US Government may reproduce, royalty-free, all or portions of this work and may authorize others to do so, for official US Government purposes only, if the US Government contract or grant so requires.
I have participated in the conception and design of this work and in the writing of the manuscript and take public responsibility for it. Neither this manuscript nor one with substantially similar content under my authorship has been published, has been submitted for publication elsewhere, or will be submitted for publication elsewhere while under consideration by The Heart Surgery Forum, except as described in an attachment. I have reviewed this manuscript (original version) and approve its submission. If I am listed above as corresponding author, I will provide all authors with information regarding this manuscript and will obtain their approval before submitting any revision. I attest to the validity, accuracy, and legitimacy of the content of the manuscript and understand that Publisher assumes no responsibility for the validity, accuracy, and legitimacy of its content. I warrant that this manuscript is original with me and that I have full power to make this Agreement. I warrant that it contains no matter that is libelous or otherwise unlawful or that invades individual privacy or infringes any copyright or other proprietary right. I agree to indemnify and hold Publisher harmless of and from any claim made against Publisher that relates to or arises out of the publication of the manuscript and agree that this indemnification shall include payment of all costs and expenses relating to the defense of any such claim, including all reasonable attorney’s fees.
I warrant that I have no financial interest in the drugs, devices, or procedures described in the manuscript (except as disclosed in the attached statement).
I state that the institutional Human Subjects Committee and/or the Ethics Committee approved the clinical protocol reported in this manuscript for the use of experimental techniques, drugs, or devices in human subjects and appropriate informed consent documents were utilized.
Furthermore, I state that any and all animals used for experimental purposes received humane care in USDA registered facilities in compliance with the “Principles of Laboratory Animal Care” formulated by the National Society for Medical Research and the “Guide for the Care and Use of Laboratory Animals” prepared by the Institute of Laboratory Animal Resources and published by the National Institutes of Health (NIH Publication No. 85-23, revised 1985).