Isolating the entire posterior left atrium improves surgical outcomes after the Cox maze procedure

Voeller, Rochus K.; Bailey, Marci S.; Zierer, Andreas; Lall, Shelly C.; Sakamoto, Shuji; Aubuchon, Kristen; Lawton, Jennifer S.; Moazami, Nader; Huddleston, Charles B.; Munfakh, Nabil A.; Moon, Marc R.; Schuessler, Richard B.; Damiano, Ralph J.

doi:10.1016/j.jtcvs.2007.10.063

Cited by 119 publications

(79 citation statements)

References 35 publications

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“…1307 Further recent work has shown significantly improved results when the entire posterior LA is excluded by the so-called box lesion. 1306,1308 …”

Section: Section 12: Surgical and Hybrid Af Ablationmentioning

confidence: 99%

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Calkins,

Kuck,

Cappato

et al. 2012

Heart Rhythm

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“…1307 Further recent work has shown significantly improved results when the entire posterior LA is excluded by the so-called box lesion. 1306,1308 …”

Section: Section 12: Surgical and Hybrid Af Ablationmentioning

confidence: 99%

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Calkins,

Kuck,

Cappato

et al. 2012

Heart Rhythm

Self Cite

1,769

1,468

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“…Of note, part of these lines were made on an anatomic basis without verifying that conduction block had indeed been established. Whether additional lesions during either CA or SA would be beneficial for specific patient populations remains to be determined 24,25 ; this study was not designed or powered to answer that question.…”

Section: Procedural Effects Of Sa and Camentioning

confidence: 99%

Atrial Fibrillation Catheter Ablation Versus Surgical Ablation Treatment (FAST)

et al. 2012

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Background-Catheter ablation (CA) and minimally invasive surgical ablation (SA) have become accepted therapy for antiarrhythmic drug-refractory atrial fibrillation. This study describes the first randomized clinical trial comparing their efficacy and safety during a 12-month follow-up. Methods and Results-One hundred twenty-four patients with antiarrhythmic drug-refractory atrial fibrillation with left atrial dilatation and hypertension (42 patients, 33%) or failed prior CA (82 patients, 67%) were randomized to CA (63 patients) or SA (61 patients). CA consisted of linear antral pulmonary vein isolation and optional additional lines. SA consisted of bipolar radiofrequency isolation of the bilateral pulmonary vein, ganglionated plexi ablation, and left atrial appendage excision with optional additional lines. Follow-up at 6 and 12 months was performed by ECG and 7-day Holter recording. The primary end point, freedom from left atrial arrhythmia Ͼ30 seconds without antiarrhythmic drugs after 12 months, was 36.5% for CA and 65.6% for SA (Pϭ0.0022). There was no difference in effect for subgroups, which was consistent at both sites. The primary safety end point of significant adverse events during the 12-month follow-up was significantly higher for SA than for CA (nϭ21 [34.4%] versus nϭ10 [15.9%]; Pϭ0.027), driven mainly by procedural complications such as pneumothorax, major bleeding, and the need for pacemaker. In the CA group, 1 patient died at 1 month of subarachnoid hemorrhage. Conclusion-In atrial fibrillation patients with dilated left atrium and hypertension or failed prior atrial fibrillation CA, SA is superior to CA in achieving freedom from left atrial arrhythmias after 12 months of follow-up, although the procedural adverse event rate is significantly higher for SA than for CA. Clinical Trial Registration-URL: http://clinicaltrials.gov. Unique identifier: NCT00662701.

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“…12) Our results revealed that isolation of the entire posterior left atrium was essential for the elimination of chronic AF during a long-term follow-up. Voeller et al 15) also reported the importance of the isolation of all pulmonary veins in the new Cox maze VI procedure, in which a complete box isolation of the whole pulmonary veins was performed using a bipolar radiofrequency clamp. The new Cox maze IV procedure improved the elimination rate of AF and decreased the occurrence of postoperative atrial tachycardia significantly as compared with the old Cox maze IV procedure (non-box pulmonary vein isolation procedure).…”

Section: Discussionmentioning

confidence: 99%

Long-Term Results after the Box Pulmonary Vein Isolation Procedure for Chronic Atrial Fibrillation in Mitral Valve Surgery

Sueda

Uchida

Takasaki

et al. 2012

ATCS

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Background: We hypothesized that chronic atrial fibrillation (AF) originated from the pulmonary veins, and was maintained by irregular activations of the posterior left atrium. We had performed the box pulmonary vein isolation procedure for the elimination of chronic AF associated with solitary mitral valve disease from 1999 to 2004. This paper evaluated the long-term results of this procedure over more than 6 years, and discussed the role of the pulmonary veins and posterior left atrium in maintaining AF. Methods: Fifty-three patients were examined after box pulmonary vein isolation procedure concomitant with solitary mitral valve surgery retrospectively. We divided the patients into two groups with or without the elimination of AF (AF group and non-AF group). The disappearance of AF was determined by electrocardiography, and atrial function was evaluated by transthoracic echocardiography. The elimination of chronic AF and the recovery of atrial systolic function after surgery were evaluated over more than 6 years of follow-up. Results: In a total of 462.8 patient years of follow-up (range 6.3 to 11.5 years, mean: 8.9 ± 2.7 years), AF disappeared in 77.3% of the patients (41/53) at 3 months and in 70.6% (36/51) of the patients at 6 years after the box pulmonary vein isolation, respectively. Among the preoperative variables, a long duration of AF and a large diameter of the left atrium were the predictive factors for recurrences of AF (p <0.05). There was no left atrial tachycardia even though we did not perform ablation towards the mitral valve annulus. Conclusions: The box pulmonary vein isolation procedure can terminate chronic AF associated with solitary mitral valve disease, and maintain a sinus rhythm for more than 6 years in 70% of chronic AF patients. This study implicates the pulmonary veins and posterior left atrium in maintaining chronic AF associated with mitral valve disease.

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Isolating the entire posterior left atrium improves surgical outcomes after the Cox maze procedure

Cited by 119 publications

References 35 publications

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

2012 HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design

Atrial Fibrillation Catheter Ablation Versus Surgical Ablation Treatment (FAST)

Long-Term Results after the Box Pulmonary Vein Isolation Procedure for Chronic Atrial Fibrillation in Mitral Valve Surgery

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