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The Cox maze procedure is the most effective surgical procedure for atrial fibrillation (AF). In recent years a number of different surgical ablation devices were introduced and new surgical ablation to treat AF are presented.
The purpose of this article was to present a new surgical ablation approach; on pump beating maze procedure via left atrial appendage (LAA) for nonvalvular AF (NVAF).
Between February 2006 and October 2012, 30 patients with persistent and paroxysmal atrial fibrillation undergoing non valvular heart disease and great vessel surgery using cardiopulmonary bypass (11 with large thrombus of left atrial appendage, 6 with graft replacement for aortic aneurysm, 9 with aortic valve replacement, 1 with ventricular septal defect, and 4 with coronary artery bypass grafting) were underwent the on pump beating maze procedure via left atrial appendage (LAA) using bipolarradiofrequency ablation concomitantly. The average age of patientswas 70 ± 8 years. The mean diameter of left atrium was 48 ± 7 mm. Six patients had paroxysmal atrialfibrillation and the other had permanent. The ablation line of our modification consisted of pulmonary box isolation and isthmus ablation. Pulmonary box isolation was made by right pulmonary epicardial clamp and LA roof and inferior clamp ablation via left atrial appendage. Left isthmus ablation between the line of pulmonary box isolation and mitral annulus was made by bipolar or monopolar pen epicardially. No further atriotomy was performed on the atrial septum or right atrium. After completion of these procedures, the combined surgery was performed. All patients in this series were operated on by the same surgical team.
No perioperative morality, cerebrovascular accidents, transient ischemic attacks, or both were documented in this series. One patient required a pacemaker implantation because of sinus node dysfunction. In a mean follow-up of 26±19 months, and 77.8 % of the patients are free from atrial fibrillation.
The LAA maze procedure could be an attractive treatment for atrial fibrillation in non-mitral cardiac surgery without the need for atriotomies.
Moderated Poster Contributions
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Atrial Fibrillation Mechanisms and Stroke Prevention
Abstract Category: 4. Arrhythmias: AF/SVT
Presentation Number: 1191M-52
- 2013 American College of Cardiology Foundation