Surgical treatment of atrial fibrillation: State of the art, 2012

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Surgical treatment of atrial fibrillation: State of the art, 2012 Takashi Nitta, Yosuke Ishii, Shun-ichiro Sakamoto Journal of Arrhythmia Volume 28, Issue 6, Pages 338-346 (December 2012) DOI: 10.1016/j.joa.2012.07.007 Copyright © 2012 Japanese Heart Rhythm Society Terms and Conditions

Fig. 1 (A) Rate of freedom from recurrence of atrial fibrillation (AF). (B) Rate of freedom from cerebral infarction. Open circle: cerebral infarction in patient with sinus rhythm. Closed circle: cerebral infarction in patient with recurrent AF. (Cited from Ref. [5] with permission: J Thorac Cardiovasc Surg. 2010;140:1332-7.). Journal of Arrhythmia 2012 28, 338-346DOI: (10.1016/j.joa.2012.07.007) Copyright © 2012 Japanese Heart Rhythm Society Terms and Conditions

Fig. 2 Meta-analysis of stroke or thromboembolism at latest follow-up. (Cited from Ref. [8] with permission: Innovations. 2010;5:84–96.) Journal of Arrhythmia 2012 28, 338-346DOI: (10.1016/j.joa.2012.07.007) Copyright © 2012 Japanese Heart Rhythm Society Terms and Conditions

Fig. 3 Outcome after the maze procedure for patients with failed radiofrequency catheter ablation. Return to sinus rhythm rate. (AA, antiarrhythmic drugs; NSR, normal sinus rhythm; SR, sinus rhythm.) (Cited from Ref. [10] with permission: Ann Thorac Surg. 2011;91:1371-7.) Journal of Arrhythmia 2012 28, 338-346DOI: (10.1016/j.joa.2012.07.007) Copyright © 2012 Japanese Heart Rhythm Society Terms and Conditions

Fig. 4 Left atrial appendage (LAA) clip, deployment tool, and deployment. (A) Reusable Miltex deployment tool, as used in all cases. The LAA clip is loaded onto the jaws of this tool. (B) LAA mobilized within the clip (1), right pulmonary veins (2), and pulmonary artery (3), and operator's hand (4) gently mobilizing the heart to demonstrate the LAA and allow placement of the clip with the left hand. (Cited from Ref. [21]: J Thorac Cardiovasc Surg. 2010;139:1269-74.) Journal of Arrhythmia 2012 28, 338-346DOI: (10.1016/j.joa.2012.07.007) Copyright © 2012 Japanese Heart Rhythm Society Terms and Conditions

Fig. 5 Confirmation of pulmonary vein (PV) isolation. Each of the 4 PVs is paced using a bipolar electrode after PV ablation. The conduction block between the PVs and the left atrium is determined by the failure of atrial capture despite the maximum output of the stimuli of the PV pacing. If any residual conduction is observed between any of the PVs and the left atrium, repeat ablation is performed until a complete conduction block is confirmed. Pacing sites (rectangles). Rt. PVs, right pulmonary veins; Lt. PVs, left pulmonary veins. (Cited from Ref. [28]: J Thorac Cardiovasc Surg. 2008;136:998–1004.) Journal of Arrhythmia 2012 28, 338-346DOI: (10.1016/j.joa.2012.07.007) Copyright © 2012 Japanese Heart Rhythm Society Terms and Conditions

Fig. 6 Flow diagram of the stepwise lesion sets. CTI, cavotricuspid isthmus; LA, left atrium; NSR, normal sinus rhythm; PVI, pulmonary vein isolation; RA, right atrium. (Cited from Ref. [33] with permission: J Am Coll Cardiol. 2012;60:54–61.) Journal of Arrhythmia 2012 28, 338-346DOI: (10.1016/j.joa.2012.07.007) Copyright © 2012 Japanese Heart Rhythm Society Terms and Conditions

Fig. 7 Box lesion set. Patients either had a single ablation line connecting the inferior right and left pulmonary veins (non-box lesion set) or had an additional ablation line connecting the superior right and left pulmonary veins (box lesion set), which electrically isolated the posterior left atrium. RF, radiofrequency. (Cited from Ref. [37] with permission: J Thorac Cardiovasc Surg. 2008;135:870-7.) Journal of Arrhythmia 2012 28, 338-346DOI: (10.1016/j.joa.2012.07.007) Copyright © 2012 Japanese Heart Rhythm Society Terms and Conditions

Fig. 8 Mean QRST area changes at 5 atrial regions before ablation (Pre-Ab), immediately after ablation (Post-Ab), and 4 weeks after ablation. Significantly increased area changes against control values (p<0.05) are indicated by shading. stim, stimulation. (Cited from Ref. [42] with permission: J Thorac Cardiovasc Surg. 2010;139:444-52.) Journal of Arrhythmia 2012 28, 338-346DOI: (10.1016/j.joa.2012.07.007) Copyright © 2012 Japanese Heart Rhythm Society Terms and Conditions