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Ann Thorac Surg 2004;77:1880
© 2004 The Society of Thoracic Surgeons

Correspondence

Efficacy of the "box" lesion pattern in the treatment of atrial fibrillation in the presence of mitral valve disease: Reply

Renato A. K. Kalil, MD, PhD, Gustavo G. Lima, MD, PhD

Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de, Cardiologia, Av Princesa Isabel, 395 Santana, 90.620-001 Porto Alegre-RS, Brazil

e-mail: kalil{at}cardnet.tche.br

To the Editor:

We acknowledge the expert comments of Bisleri and colleagues regarding our technique for pulmonary vein isolation. We now have operated on 38 patients in chronic atrial fibrillation (AF) secondary to mitral valve disease, and the results remain similar to those in the report [1]. This has become our procedure of choice for chronic AF. The authors are correct in stating that this procedure can be difficult in some patients, especially when cutting the left part of the atrium. Some sort of ablation in that area, if possible, could help overcome the problem, but one must bear in mind that a complete transmural lesion is needed and that this can be guaranteed only by the cut-and-sew technique. Suture line bleeding is always a risk, but it has not been greater in our series than with mitral valve operation alone. Cross-clamp time is increased by 20 to 30 minutes and should decrease as we gain experience.

We have not compared this technique with others except our previous experience with the Cox maze operation and mitral valve operation alone. A prospective, randomized series comparing these three operations was conducted recently (unpublished observations).

We agree completely that this small series demonstrates that chronic AF can be effectively treated with simple electrical exclusion of all pulmonary veins from the rest of the heart. This fact may facilitate the development of minimally invasive or videothoracoscopic procedures that combine the convenience of ablative devices and the simplicity of this lesion pattern for pulmonary vein isolation.

We thank our colleagues for their interest in surgical procedures for AF.

References

  1. Kalil R.A.K., Lima G.G., Leiria T.L.L., et al. Simple surgical isolation of pulmonary veins for treating secondary atrial fibrillation in mitral valve disease. Ann Thorac Surg 2002;73:1169-1173.[Abstract/Free Full Text]




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