Abstract
The Cox-Maze procedure was introduced 20 years ago and has become the gold standard for the surgical treatment of atrial fibrillation. Data recorded during surgery and catheter ablations have provided new insights into the mechanisms of human atrial fibrillation. These data, plus the results of surgical and catheter ablation, suggest a patient-specific approach to the surgical treatment of atrial fibrillation.
Similar content being viewed by others
References
Moss, A. J. (2003). History of atrial fibrillation. Annals of Noninvasive Electrocardiology, 8(1), 90–91.
Cox, J. L., Schuessler, R. B., & Boineau, J. P. (1991). The surgical treatment of atrial fibrillation. I. Summary of the current concepts of the mechanisms of atrial flutter and atrial fibrillation. Journal of Thoracic Cardiovascular Surgery, 101(3), 402–405.
Garrey, W. (1914). The natrue of fibrillary contraction of the heart: Its relation to tissue mass and form. American Journal of Physiology, 33, 397–414.
Lewis, T. (1920). Observations upon flutter and fibrillation: Part IV. Impure flutter: Theory of circus movement. Heart, 7, 293.
Moe, G. K. (1962). On the multiple wavelet hypothesis of atrial fibrillation. Archives Internationales de Pharmacodynamie, 140, 183–188.
Moe, G. K., Rheinholt, W. C., & Abildskov, J. A. (1964). A computer model of atrial fibrillation. American Heart Journal, 200–220, 67.
Allessie, M. A., Lammers, W. J. E. P., & Bonke, F. I. M. (1985). Experimental evaluation of Moe’s multiple wavelet hypothesis of atrial fibrillation. New York: Grune and Stratton.
Cox, J. L., Canavan, T. E., Schuessler, R. B., Cain, M. E., Lindsay, B. D., Stone, C., 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. Journal of Thoracic Cardiovascular Surgery, 101(3), 406–426.
Cox, J. L., Schuessler, R. B., D’Agostino, H. J. Jr., Stone, C. M., Chang, B. C., Cain, M. E., et al. (1991). The surgical treatment of atrial fibrillation. III. Development of a definitive surgical procedure. Journal of Thoracic Cardiovascular Surgery, 101(4), 569–583.
Cobb, F. R., Blumenschein, S. D., Sealy, W. C., Boineau, J. P., Wagner, G. S., & Wallace, A. G. (1968). Successful surgical interruption of the bundle of Kent in a patient with Wolff-Parkinson-White syndrome. Circulation, 38(6), 1018–1029.
Cox, J. L., Boineau, J. P., Schuessler, R. B., Kater, K. M., Lappas, D. G. (1994). From fisherman to fibrillation: An unbroken line of progress. Annals of Thoracic Surgery, 58(4), 1269–1273.
Prasad, S. M., Maniar, H. S., Camillo, C. J., Schuessler, R. B., Boineau, J. P., Sundt, T. M. III, et al. (2003). The Cox maze III procedure for atrial fibrillation: Long-term efficacy in patients undergoing lone versus concomitant procedures. Journal of Thoracic Cardiovascular Surgery, 126(6), 1822–1828.
Gaynor, S. L., Schuessler, R. B., Bailey, M. S., Ishii, Y., Boineau, J. P., Gleva, M. J., et al. (2005). Surgical treatment of atrial fibrillation: Predictors of late recurrence. Journal of Thoracic Cardiovascular Surgery, 129(1), 104–111.
Ishii, Y., Gleva, M. J., Gamache, M. C., Schuessler, R. B., Boineau, J. P., Bailey, M. S., et al. (2004). Atrial tachyarrhythmias after the maze procedure: Incidence and prognosis. Circulation, 110(11 Suppl 1), II164–168.
Kosakai, Y. (2000). Treatment of atrial fibrillation using the Maze procedure: The Japanese experience. Seminars in Thoracic Cardiovascular Surgery, 12(1), 44–52.
Gillinov, A. M., Sirak, J., Blackstone, E. H., McCarthy, P. M., Rajeswaran, J., Pettersson, G., et al. (2005). The Cox maze procedure in mitral valve disease: Predictors of recurrent atrial fibrillation. Journal of Thoracic Cardiovascular Surgery, 130(6), 1653–1660.
Haissaguerre, M., Jais, P., Shah, D. C., Gencel, L., Pradeau, V., Garrigues, S., et al. (1996). Right and left atrial radiofrequency catheter therapy of paroxysmal atrial fibrillation. Journal of Cardiovascular Electrophysiology, 7(12), 1132–1144.
Haissaguerre, M., Shah, D. C., Jais, P., Hocini, M., Yamane, T., Deisenhofer, I., et al. (2000). Mapping-guided ablation of pulmonary veins to cure atrial fibrillation. American Journal of Cardiology, 86(9A), 9K–19K.
Oral, H., Chugh, A., Good, E., Sankaran, S., Reich, S. S., Igic, P., et al. (2006). A tailored approach to catheter ablation of paroxysmal atrial fibrillation.[see comment]. Circulation, 113(15), 1824–1831.
Earley, M. J., & Schilling, R. J. (2006). Catheter and surgical ablation of atrial fibrillation. Heart, 92(2), 266–274.
Pappone, C., & Santinelli, V. (2005). Atrial fibrillation ablation: State of the art. American Journal of Cardiology, 96(12A), 59L–64L.
Oral, H., Pappone, C., Chugh, A., Good, E., Bogun, F., Pelosi, F., Jr., et al. (2006). Circumferential pulmonary-vein ablation for chronic atrial fibrillation. [see comment]. New England Journal of Medicine, 354(9), 934–941.
Lim, T. W., Jassal, I. S., Ross, D. L., & Thomas, S. P. (2006). Medium-term efficacy of segmental ostial pulmonary vein isolation for the treatment of permanent and persistent atrial fibrillation. Pacing and Clinical Electrophysiology, 29(4), 374–379.
Melby, S. J., Zierer, A., Bailey, M. S., Cox, J. L., Lawton, J. S., Munfakh, N., et al. (2006). A new era in the surgical treatment of atrial fibrillation: The impact of ablation technology and lesion set on procedural efficacy. Annals of Surgery, 244(4), 583–592.
Nitta, T., Ohmori, H., Sakamoto, S., Miyagi, Y., Kanno, S., & Shimizu, K. (2005). Map-guided surgery for atrial fibrillation. Journal of Thoracic Cardiovascular Surgery, 129(2), 291–299.
Nitta, T., Ishii, Y., Miyagi, Y., Ohmori, H., Sakamoto, S., & Tanaka, S. (2004). Concurrent multiple left atrial focal activations with fibrillatory conduction and right atrial focal or reentrant activation as the mechanism in atrial fibrillation. Journal of Thoracic Cardiovascular Surgery, 127(3), 770–778.
Schuessler, R. B., Kay, M. W., Melby, S. J., Branham, B. H., Boineau, J. P., & Damiano, R. J. (2006). Spatial and temporal stability of the dominant frequency of activation in human atrial fibrillation. Journal of Electrocardiology, 39, S7–S12.
Sahadevan, J., Ryu, K., Peltz, L., Khrestian, C. M., Stewart, R. W., Markowitz, A. H., et al. (2004). Epicardial mapping of chronic atrial fibrillation in patients: Preliminary observations. Circulation, 110(21), 3293–3299.
Schuessler, R. B., Grayson, T. M., Bromberg, B. I., Cox, J. L., & Boineau, J. P. (1992). Cholinergically mediated tachyarrhythmias induced by a single extrastimulus in the isolated canine right atrium. Circulation Research, 71(5), 1254–1267.
Cox, J. L., Jaquiss, R. D., Schuessler, R. B., & Boineau, J. P. (1995). Modification of the maze procedure for atrial flutter and atrial fibrillation. II. Surgical technique of the maze III procedure. Journal of Thoracic Cardiovascular Surgery, 110(2), 485–495.
Li, D., Melnyk, P., Feng, J., Wang, Z., Petrecca, K., Shrier, A., & Nattel, S. (2000). Effects of experimental heart failure on atrial cellular and ionic electrophysiology. Circulation, 101(22), 2631–2638.
Wijffels, M. C., Kirchhof, C. J., Dorland, R., & Allessie, M. A. (1995). Atrial fibrillation begets atrial fibrillation. A study in awake chronically instrumented goats. Circulation, 92(7), 1954–1968.
Kneller, J., Sun, H., Leblanc, N., & Nattel, S. (2002). Remodeling of Ca(2+)-handling by atrial tachycardia: Evidence for a role in loss of rate-adaptation. Cardiovascular Research, 54(2), 416–426.
Yue, L., Melnyk, P., Gaspo, R., Wang, Z., & Nattel, S. (1999). Molecular mechanisms underlying ionic remodeling in a dog model of atrial fibrillation. Circulation Research, 84(7), 776–784.
Schotten, U., Haase, H., Frechen, D., Greiser, M., Stellbrink, C., Vazquez-Jimenez, J. F., et al. (2003). The L-type Ca2+-channel subunits alpha1C and beta2 are not downregulated in atrial myocardium of patients with chronic atrial fibrillation. Journal of Molecular and Cellular Cardiology, 35(5), 437–443.
Schotten, U., Ausma, J., Stellbrink, C., Sabatschus, I., Vogel, M., Frechen, D., et al. (2001). Cellular mechanisms of depressed atrial contractility in patients with chronic atrial fibrillation. Circulation, 103(5), 691–698.
Van Wagoner, D. R. (2003). Electrophysiological remodeling in human atrial fibrillation. Pacing & Clinical Electrophysiology, 26(7 Pt 2), 1572–1575.
Schaff, H. V., Dearani, J. A., Daly, R. C., Orszulak, T. A., & Danielson, G. K. (2000). Cox-Maze procedure for atrial fibrillation: Mayo Clinic experience. Seminars in Thoracic Cardiovascular Surgery, 12(1), 30–37.
Ramanathan, C., Jia, P., Ghanem, R., Ryu, K., & Rudy, Y. (2006). Activation and repolarization of the normal human heart under complete physiological conditions. Proceedings of the National Academy of Sciences of USA, 103(16), 6309–6314.
Wang, Y., & Rudy, Y. (2006). Application of the method of fundamental solutions to potential-based inverse electrocardiography. Annals of Biomedical Engineering, 34(8), 1272–1288.
Ghanem, R. N., Jia, P., Ramanathan, C., Ryu, K., Markowitz, A., & Rudy, Y. (2005). Noninvasive electrocardiographic imaging (ECGI): Comparison to intraoperative mapping in patients.[see comment]. Heart Rhythm, 2(4), 339–354.
Rudy, Y. (2005). Noninvasive electrocardiographic imaging in humans. Journal of Electrocardiology, 38(4 Suppl), 138–139.
Kim, K. B., Rodefeld, M. D., Schuessler, R. B., Cox, J. L., & Boineau, J. P. (1996). Relationship between local atrial fibrillation interval and refractory period in the isolated canine atrium. Circulation, 94(11), 2961–2967.
Bayly, P. V., KenKnight, B. H., Rogers, J. M., Hillsley, R. E., Ideker, R. E., & Smith, W. M. (1998). Estimation of conduction velocity vector fields from epicardial mapping data. IEEE Transactions on Biomedical Engineering, 45(5), 563–571.
Author information
Authors and Affiliations
Corresponding author
Additional information
Supported by: NIH R01 032257-21
Rights and permissions
About this article
Cite this article
Schuessler, R.B., Damiano, R.J. Mechanisms of human atrial fibrillation: Lessons learned from 20 years of atrial fibrillation surgery. J Interv Card Electrophysiol 20, 59–64 (2007). https://doi.org/10.1007/s10840-007-9175-0
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10840-007-9175-0