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Ann Thorac Surg 2001;72:1793
© 2001 The Society of Thoracic Surgeons

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Correspondence

Leaving a corridor after the maze procedure: letter 1

^a Cardiothoracic Surgery, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan

e-mail: nitta_takashi/surg2{at}nms.ac.jp

To the Editor

I read with interest the article by Kim and colleagues [1] and congratulate them on their excellent results with their modifications to the maze procedure. One of the important principles in designing or modifying a surgical procedure for atrial fibrillation is to extend the atrial incisions down to the atrioventricular annulus or to connect the incisions with each other [2]. This is to eliminate all the potential macroreentrant circuits conducting through a pathway between the incisions, the anatomical barriers, or both. Experimental studies on animals and clinical experience to date have suggested that failure to do this can result in postoperative occurrence of atrial flutter, a more troublesome tachyarrhythmia than atrial fibrillation [2–4].

In each schema of the modifications of the maze procedure presented by the authors, a circular corridor between the atriotomies can be clearly traced: from the lateral right atrium to the interatrial septum in modification I and from the posterior left atrium to the interatrial septum in modification II. Although the incidence of postoperative atrial flutter is not clear in the report, both of the modifications are likely to fail in a substantial number of patients. However, both circuits can easily be interrupted by adding a simple incision or linear cryoablation to connect the incisions with each other. Furthermore, the former circuit coincides with the reentrant circuit of the common atrial flutter, which is now easily treated with a high success rate by catheter ablation of the isthmus between the tricuspid valve annulus and the inferior vena cava.

Kim and associates are to be highly praised for their successful modifications of the maze procedure either to shorten the aortic cross-clamp and bypass time or to improve left atrial contractility. I hope they will continue to contribute to this field and will develop a more sophisticated procedure that is less invasive, preserves better atrial transport function, and eliminates the risk of postoperative atrial flutter.

References

1. Kim K.-B., Huh J.-H., Kang C.H., Ahn H., Sohn D.-W. Modifications of the Cox-Maze III procedure. Ann Thorac Surg 2001;71:816-822.[Abstract/Free Full Text]
2. Cox J.L., Schuessler R.B., D’Agostino H.J., Jr, et al. The surgical treatment of atrial fibrillation. III. Development of a definitive surgical procedure. J Thorac Cardiovasc Surg 1991;101:569-583.[Abstract]
3. Frame L.H., Page R.L., Hoffman B.F. Atrial reentry around an anatomic barrier with a partially refractory excitable gap. A canine model of atrial flutter. Circ Res 1986;58:495-511.[Abstract/Free Full Text]
4. Cox J.L. Evolving applications of the maze procedure for atrial fibrillation. Ann Thorac Surg 1993;55:578-580.[Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Takashi Nitta Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Nitta, T. Search for Related Content PubMed Articles by Nitta, T. Related Collections Electrophysiology - arrhythmias Related Article