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Atrial Fibrillation Surgery

  • Narain Moorjani
  • Bushra S. Rana
  • Francis C. Wells
Chapter

Abstract

A 65 year-old gentleman presented with a progressive history of increasing exertional dyspnoea, associated with frequent palpitations. He had no previous history of rheumatic fever or infective endocarditis but had been diagnosed with atrial fibrillation 6 months previously. Medical management included amiodarone therapy and an electrical cardioversion, which had failed to provide sustained freedom from the atrial arrhythmia. In view of this, he was also being managed with warfarin anti-coagulation therapy. His electrocardiogram had shown absence of P waves and an irregular ventricular response, consistent with his atrial fibrillation (Fig. 18.1). Cardiac catheterisation had demonstrated no obstructive coronary artery disease. Trans-thoracic and trans-oesophageal echocardiography had revealed an anterior directed jet of severe mitral regurgitation caused by prolapse of the posterior mitral valve leaflet, dilated left atrium (diameter 5.64 cm), enlarged left ventricle (left ventricular end-diastolic diameter 6.1 cm) and some impairment of left ventricular function (ejection fraction 48%).

Keywords

Atrial fibrillation Ablation Pulmonary vein isolation Posterior left atrial box lesion set Cox-maze IV procedure Focal areas of automaticity Thromboembolism Macro re-entry circuits Bipolar radiofrequency ablation Cryoablation Left atrial appendage excision 

Recommended Reading

  1. Cox JL. The surgical treatment of atrial fibrillation. IV. Surgical technique. J Thorac Cardiovasc Surg. 1991;101:584–92.PubMedGoogle Scholar
  2. Damiano RJ Jr, Schwartz FH, Bailey MS, Maniar HS, Munfakh NA, Moon MR, Schuessler RB. The Cox maze IV procedure: predictors of late recurrence. J Thorac Cardiovasc Surg. 2011;141:113–21.CrossRefGoogle Scholar
  3. Dunning J, Nagendran M, Alfieri OR, Elia S, Kappetein AP, Lockowandt U, Sarris GE, Kolh PH. Guideline for the surgical treatment of atrial fibrillation. Eur J Cardiothorac Surg. 2013;44:777–91.CrossRefGoogle Scholar
  4. Gillinov AM, Gelijns AC, Parides MK, DeRose JJ, Moskowitz AJ, Voisine P, Ailawadi G, Bouchard D, Smith PK, Mack MJ, Acker MA, Mullen JC, Rose EA, Chang HL, Puskas JD, Couderc JP, Gardner TJ, Varghese R, Horvath KA, Bolling SF, Michler RE, Geller NL, Ascheim DD, Miller MA, Bagiella E, Moquete EG, Williams P, Taddei-Peters WC, O’Gara PT, Blackstone EH, Argenziano M, CTSN Investigators. Surgical ablation of atrial fibrillation during mitral-valve surgery. N Engl J Med. 2015;372:1399–409.CrossRefGoogle Scholar
  5. January CT, Wann LS, Alpert JS, Calkins H, Cigarroa JE, Cleveland JC Jr, Conti JB, Ellinor PT, Ezekowitz MD, Field ME, Murray KT, Sacco RL, Stevenson WG, Tchou PJ, Tracy CM, Yancy CW, ACC/AHA Task Force Members. 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines and the Heart Rhythm Society. Circulation. 2014;130(23):e199–267.PubMedPubMedCentralGoogle Scholar
  6. Kanderian AS, Gillinov AM, Pettersson GB, Blackstone E, Klein AL. Success of surgical left atrial appendage closure: assessment by transesophageal echocardiography. J Am Coll Cardiol. 2008;52:924–9.CrossRefGoogle Scholar
  7. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, Castella M, Diener HC, Heidbuchel H, Hendriks J, Hindricks G, Manolis AS, Oldgren J, Popescu BA, Schotten U, Van Putte B, Vardas P, Agewall S, Camm J, Baron Esquivias G, Budts W, Carerj S, Casselman F, Coca A, De Caterina R, Deftereos S, Dobrev D, Ferro JM, Filippatos G, Fitzsimons D, Gorenek B, Guenoun M, Hohnloser SH, Kolh P, Lip GY, Manolis A, McMurray J, Ponikowski P, Rosenhek R, Ruschitzka F, Savelieva I, Sharma S, Suwalski P, Tamargo JL, Taylor CJ, Van Gelder IC, Voors AA, Windecker S, Zamorano JL, Zeppenfeld K. 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur J Cardiothorac Surg. 2016;50(5):e1–e88.CrossRefGoogle Scholar
  8. Shemin RJ, Cox JL, Gillinov AM, Blackstone EH, Bridges CR. Guidelines for reporting data and outcomes for the surgical treatment of atrial fibrillation. Ann Thorac Surg. 2007;83:1225–30.CrossRefGoogle Scholar
  9. Soltesz E, Gillinov M. Ablation of atrial fibrillation with concomitant surgery. Op Tech Thorac Cardiovasc Surg. 2009;14(3):193–207.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag London Ltd., part of Springer Nature 2018

Authors and Affiliations

  • Narain Moorjani
    • 1
  • Bushra S. Rana
    • 2
  • Francis C. Wells
    • 1
  1. 1.Department of Cardiothoracic SurgeryRoyal Papworth HospitalCambridgeUK
  2. 2.Department of CardiologyRoyal Papworth HospitalCambridgeUK

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