The Influence of Simplified Surgical Procedures on the Surgical Treatment for Atrial Fibrillation with using the Cut-and-Sew Technique

Choi, Jong Bum; Kim, Jong Hun; Lee, Mi Kyung; Lee, Sam Youn; Kim, Min Ho; Kim, Kong Su

Abstract

BACKGROUND: The Cox maze-III procedure is considered as the most effective surgical treatment for atrial fibrillation. Because this procedure takes a long time and it complicates the concomitant cardiac surgery, some surgeons perform a left atrial maze procedure or pulmonary vein isolation only to reduce the operation time. This study was performed to evaluate how the modified procedures, with using cut-and-sew techniques, can influence the treatment of atrial fibrillation. MATERIAL AND METHOD: Between Feb 1999 and June 2005, 40 patients (17 males and 23 females) with organic heart disease and atrial fibrillation underwent the Cox maze-III procedure (23), the left atrial maze procedure (10) or pulmonary vein isolation (7). The cut-an-sew technique was used to ablate the atrial wall, but cryoablation was used instead of the cut-and-sew technique for the coronary sinus and the inferior wall between the pulmonary vein and the mitral annulus. RESULT: After a mean follow-up period of 50.0+/-21.6 months, all (100%) of the 23 patients who underwent the Cox maze-III procedure had regular sinus or atrial rhythm conversion, and 7 (70%) of 10 with a left atrial maze procedure and 4 (57.1%) of 7 with pulmonary vein isolation had regular sinus or atrial rhythm conversion (p=0.002).
CONCLUSION
To obtain a high conversion rate from atrial fibrillation to a regular sinus rhythm or a regular atrial rhythm, the standard Cox maze-III procedure should be performed in both atria. The limited modified procedures like the left atrial maze procedure or pulmonary vein isolation may reduce the cure rate of atrial fibrillation.