Abstract
The Cox-Maze procedure and less complex modifications have gained widespread use as a treatment modality for patients with concomitant atrial fibrillation. Hypothermic or hyperthermic energy sources play a significant role in rapidly creating linear lesions. Endocardial ablation is easy to perform and effective with different energy sources. Epicardial techniques may simplify the procedure by allowing surgery on a beating heart. But epicardial fat and the heat sink effect of the flowing endocardial blood are obstacles to effective ablation. New devices using bipolar (irrigated) radiofrequency, microwave or laser energy, cryoablation or focused ultrasound are in clinical or pre-clinical stages and permit lesions to be created on a beating heart without cardiopulmonary bypass. Minimally invasive or video-assisted surgical techniques and effective devices for epicardial ablation will enable the treatment of patients suffering from lone atrial fibrillation. To facilitate the comparison between different techniques and devices, guidelines for reporting clinical results are necessary.
Zusammenfassung
Die Cox-Maze-Operation und ihre chirurgisch weniger komplexen Modifikationen sind heute zur Behandlung des Vorhofflimmerns begleitend zu anderen herzchirurgischen Eingriffen weitgehend anerkannt. Durch eine Ablation des Vorhofmyokards mit Kälte oder Hitze können rasch lineare Läsionen erzeugt werden. Das endokardiale Vorgehen unter Verwendung unterschiedlicher Energiequellen hat sich als technisch einfach und effektiv erwiesen. Mit epikardialen Techniken kann die Prozedur weiter vereinfacht und am schlagenden Herzen durchgeführt werden. Hindernisse für die Gewährleistung transmuraler Linien sind das epikardiale Fettgewebe und der kühlende oder erwärmende Effekt des subendokardialen Blutflusses. Neue Sondentechnologien unter Verwendung von bipolarer (gekühlter) Radiofrequenz-, Mikrowellen- oder Laserenergie, Cryoablation oder fokusiertem Ultraschall sind derzeit in vor- oder klinischer Erprobung. Damit sollten auch am schlagenden Herzen ohne Einsatz der Herzlungenmaschine transmurale Läsionen realisierbar sein. Mit diesen neuen Technologien und einem minimalinvasiven oder endoskopischen chirurgischen Vorgehen kann auch für Patienten mit „lone atrial fibrillation“ eine alternative Therapieform angeboten werden. Zur besseren Erfassung und zum wissenschaftlichen Vergleich der unterschiedlichen Techniken sind Empfehlungen zur einheitlichen Sammlung und Auswertung klinischer Daten notwendig.
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Hemmer, W., Böhm, J.O. Zukunftsvisionen und neue Technologien in der chirurgischen Behandlung des Vorhofflimmerns. Herzschr. Elektrophys. 18, 92–100 (2007). https://doi.org/10.1007/s00399-007-0560-2
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DOI: https://doi.org/10.1007/s00399-007-0560-2