Ann Thorac Surg 2005;80:1086
© 2005 The Society of Thoracic Surgeons
New technology
Invited commentary
Miralem Pasic, MD, PhD,
Roland Hetzer, MD, PhD
Deutsches Herzzentrum Berlin, Augustenburger Platz 1, Berlin, D-13353 Germany
(Email: pasic{at}dhzb.de).
Kubota and colleagues [1] report their experimental experience with atrial fibrillation surgery on the beating heart. They confirm the potential for an alternative energy source, an infrared coagulator, and for the modified maze procedure. The article represents a contribution to the general surgical question: "How should we treat a patient with chronic atrial fibrillation undergoing open heart procedure?" Or more precisely, the question is: "What is the best surgical method to treat a patient with chronic atrial fibrillation?"
The Cox maze III operation is the gold standard for surgical therapy of chronic atrial fibrillation. Several modified maze procedures are used in order to simplify the surgical procedure (and limit the amount of surgery) and to reduce the duration of cardiopulmonary bypass, aortic cross-clamp time, and operating time. All are based on the original concept of the maze procedure developed and introduced by James Cox. Instead of cutting the atrial wall, application of radiofrequency current (or another type of energy, [eg, cryoablation, microwave, laser]) replaces the incisions and sutures of the standard maze technique. There is a spectrum of modifications regarding the (1) directions of the maze lines, (2) location of the procedure (left atrium, right atrium or both), (3) type of energy (radio-frequency, microwave, cryoablation, laser), (4) modes of application (endocardial or epicardial), (5) types of surgical probe used for ablation, (6) use of cardioplegia (beating-heart vs cardioplegic surgery), (7) use of cardiopulmonary bypass ("on-pump" vs "off-pump"), and (8) type of surgical approach (standard vs minimally invasive).
The aims of surgery for chronic atrial fibrillation remain unchanged: (1) restoration of a stable sinus rhythm, and (2) improvement of mechanical function of the left atrium. The question "What is the best surgical method to treat a patient with chronic atrial fibrillation?" is still open, and the answer still being sought. We need a simple method that can be carried out in a short time eliminating atrial fibrillation with a success rate comparable with that of the standard Cox maze III technique. There is a need for clinical studies comparing different ablation systems and surgical modifications based on long-term results.
We congratulate the colleagues from Tokyo on their excellent experimental electrophysiological study. Their article undoubtedly increases the pool of possible solutions for surgical treatment of patients with chronic atrial fibrillation.
 |
References
|
|---|
- Kubota H, Takamoto S, Furuse A, et al. Epicardial maze procedure on the beating heart with an infrared coagulator Ann Thorac Surg 2005;80:1081-1086.[Abstract/Free Full Text]
Top
References