A new era in the surgical treatment of atrial fibrillation: the impact of ablation technology and lesion set on procedural efficacy.

摘要: Atrial fibrillation (AF) is the most common sustained arrhythmia in United States. Adults over age of 40 years have a 25% risk developing AF during their lives.1,2 Because has detrimental sequelae, including symptoms from tachyarrhythmias, hemodynamic compromise, and thromboembolic complications, many treatment strategies been developed to alleviate disease. Antiarrhythmic drugs, catheter-based ablation, surgery all used with varying efficacies. Unfortunately, medical therapy significant limitations antiarrhythmic drugs recurrence rates more than 60% some series.3,4 Catheter ablation reported short- mid-term cure 59% 91%, respectively, at variable follow-up.5 The surgical successful Cox-Maze III procedure, which long-term 90%.6,7 Although procedure had excellent efficacy,6 cut-and-sew technique was technically challenging carry out few surgeons routinely performed operation. Recent technologic advancements devices provided possibility performing modified by replacing or traditional incisions lines ablation. At our institution, laboratory results using bipolar radiofrequency (RF) clamp8,9 led development modification original first 2002. In this termed IV, lesions conventional version are replaced linear RF energy.10 Early experience IV recorded comparable success freedom last follow-up greater 90%.11 The involved creation myriad on atria originally designed prevent macro-reentrant circuits that were felt be responsible for initiation and/or maintenance AF.12 Speculation concerning conduction block essential treating several different operations involving limited lesion sets. These included only left atrial lesions, right pulmonary vein isolation alone, combination lesions.13,14 Using mapping techniques, groups found cases initiate ectopic beats foci veins.15–17 use ablations isolate veins treat shown short-term near 80%.5 As result, it suggested considered as first-line AF.18,19 Surgeons also attempted fewer but reports scarce. The purpose study examine 130 patients undergoing alone compare them historical cohort “cut-and-sew” procedure.