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. 2014 Jan;3(1):124-9.
doi: 10.3978/j.issn.2225-319X.2013.12.02.

The problem with concomitant atrial fibrillation in non-mitral valve surgery

Mark La Meir  1 , Sandro Gelsomino  2 , Bart Nonneman  3
Affiliations

The problem with concomitant atrial fibrillation in non-mitral valve surgery

Mark La Meir et al. Ann Cardiothorac Surg. 2014 Jan.

Abstract

Treatment of atrial fibrillation (AF) in concomitant surgery is not unanimously agreed upon in the cardiac surgical community. The reason for this lack of consensus is threefold. Firstly, there is an absence of large multicenter randomized controlled trials (RCT) proving the benefit of restoring sinus rhythm in a patient population which we encounter almost daily (about 10% of cardiac surgery patients are diagnosed with AF). Secondly, for patients undergoing cardiac surgery without the need for an atriotomy, the Maze procedure is not widely accepted. In these patients, many surgeons do not think that the increased complexity outweighs the potential future benefits of sinus rhythm. Thirdly, due to our limited understanding of this pathology, we are confronted with many choices of ablation tools and lesion sets. In this perspective these issues are reviewed. As a possible solution, a total epicardial lesion set without any incisions is proposed.

Keywords: Atrial fibrillation (AF); concomitant surgery; epicardial.

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Figures

Figure 1
Figure 1
Blunt dissection of left pulmonary veins, medial to ligament of Marshall (LM). LSPV, left superior pulmonary vein; LAA, left atrial appendage.
Figure 2
Figure 2
Bipolar clamping of left pulmonary veins antrum, medial to ligament of Marshall (LM). LSPV, left superior pulmonary vein.
Figure 3
Figure 3
Bipolar clamping of posterior wall of the left atrium as seen from the right. Arrow points to antral ablation line of right PVs. SVC, superior caval vein; IVC, inferior caval vein; PVs, pulmonary veins.
Figure 4
Figure 4
Bipolar clamping of posterior wall of the left atrium as seen from the left. Arrow points to antral ablation line of left pulmonary veins. LM, ligament of Marshal; LSPV, left superior pulmonary vein; LAA, left atrial appendage.
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