Advertisement

World Journal of Surgery

, Volume 32, Issue 3, pp 346–349 | Cite as

Current Status of the Surgical Treatment of Atrial Fibrillation

  • Alexander S. Geha
  • Khaled Abdelhady
Article

Abstract

Atrial fibrillation (AF) affects several million patients worldwide and is associated with a number of heart conditions, particularly coronary artery disease, rheumatic heart disease, hypertension, and congestive heart failure. The treatment of AF and its complications is quite costly. Atrial fibrillation usually results from multiple macro-re-entrant circuits in the left atrium. Very frequently, particularly in association with mitral valve disease, these circuits arise from the area of the junction of the pulmonary venous endothelium and the left atrial endocardium. Pharmacological therapy is at best 50% effective. Therapeutic options for AF include antiarrhythmic drugs, cardioversion, atrioventricular (A-V) node block, pacemaker insertion, and ablative surgery. In 1987, Cox developed an effective surgical procedure to achieve ablation. Current ablative procedures include the classic cut-and-sew Maze operation or a modification of it, namely through catheter ablation, namely, cryoablation, radiofrequency ablation (dry or irrigated), and other forms of ablation (e.g., laser, microwave). These procedures will be described, along with the indications, advantages and disadvantages of each. Special emphasis on the alternative means to cutting and sewing to achieve appropriate effective atrial scars will be stressed, and our experience with these approaches in 50 patients with AF and associated cardiac lesions and their outcomes is presented.

Keywords

Atrial Fibrillation Pulmonary Vein Left Atrium Coronary Sinus Atrial Flutter 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

References

  1. 1.
    Kannel WB, Wolf PA, Benjamin EJ et al. (1998) Prevalence, incidence, prognosis and predisposing conditions for atrial fibrillation: population-based estimates. Am J Cardiol 82:2N–9NPubMedCrossRefGoogle Scholar
  2. 2.
    Benjamin EJ, Eolf PA, D’Agostino RB et al. (1998) Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation 98:946–952PubMedGoogle Scholar
  3. 3.
    Wolf PA, Mitchell JB, Baker CS et al. (1998) Impact of atrial fibrillation on mortality, stroke, and medical costs. Arch Intern Med 158:229–234PubMedCrossRefGoogle Scholar
  4. 4.
    Cox JL (2003) Atrial fibrillation. I. A new classification system. J Thorac Cardiovas Surg 126:1686–1692CrossRefGoogle Scholar
  5. 5.
    Cox JL (2003) Atrial fibrillation. II. Rationale for surgical treatment. J Thorac Cardiovasc Surg. 126:1693–1699PubMedCrossRefGoogle Scholar
  6. 6.
    Cox JL, Schuessler RB, Cain ME et al. (1989) Surgery for atrial fibrillation. Semin Thorac Cardiovasc Surg 1:67–73PubMedGoogle Scholar
  7. 7.
    Cox JL, Canavan TE, Schuessler RB et al. (1991) The surgical treatment of atrial fibrillation. II. Intraoperative electrophysiologic mapping and description of the electrophysiologic basis of atrial flutter and atrial fibrillation. J Thorac Cardiovasc Surg 101:406–426PubMedGoogle Scholar
  8. 8.
    Haissaguerre M, Jais P, Shah DC et al. (1998) Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 339:659–666PubMedCrossRefGoogle Scholar
  9. 9.
    Schmitt C, Ndrepepa G, Weber S et al. (2002) Biatrial multisite mapping of atrial premature complexes triggering onset of atrial fibrillation. Am J Cardiol 89:1381–1387PubMedCrossRefGoogle Scholar
  10. 10.
    Allessie MA (1999) Atrial fibrillation-induced electrical remodeling in humans: what is the next step? Cardiovasc Res 44:10–12PubMedCrossRefGoogle Scholar
  11. 11.
    Cox JL (2004) Surgical treatment of atrial fibrillation: a review. Europace 5:S20–29PubMedCrossRefGoogle Scholar
  12. 12.
    Harada A, Konishi T, Fukata M et al. (2000) Intraoperative map guided operation for atrial fibrillation due to mitral valve disease. Ann Thorac Surg 69:446–450PubMedCrossRefGoogle Scholar
  13. 13.
    Lammers WJ, Schalij MJ, Kirchhof CJ et al. (1990) Quantification of spatial inhomogeneity in conduction and initiation of reentrant atrial arrhythmias. Am J Physiol 259(4 Pt 2):H1254–H1263PubMedGoogle Scholar
  14. 14.
    Cox JL, Ad N (2000) The importance of cryoablation of the coronary sinus during the Maze procedure. Semin Thorac Cardiovasc Surg 12:20–24PubMedCrossRefGoogle Scholar
  15. 15.
    Wisser W, Aigner C, Stix G et al. (2007) Permanent chronic atrial fibrillation: pulmonary vein isolation alone is not enough. Ann Thorac Surg 84:1151–1157PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2007

Authors and Affiliations

  1. 1.Division of Cardiothoracic SurgeryThe University of Illinois Medical Center at ChicagoChicagoUnited States

Personalised recommendations