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The Journal of Thoracic and Cardiovascular Surgery, Vol 101, 406-426, Copyright © 1991 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

The surgical treatment of atrial fibrillation. II. Intraoperative electrophysiologic mapping and description of the electrophysiologic basis of atrial flutter and atrial fibrillation

JL Cox, TE Canavan, RB Schuessler, ME Cain, BD Lindsay, C Stone, PK Smith, PB Corr and JP Boineau
Department of Surgery, Washington University School of Medicine, Barnes Hospital, St. Louis, Mo. 63110.

Computerized mapping of atrial fibrillation was performed in animals and man. To study atrial fibrillation in a systematic manner, we developed a clinically relevant experimental model of atrial fibrillation. Chronic mitral regurgitation was created surgically in 25 dogs without opening the pericardium. After several months of chronic mitral regurgitation, the atria became enlarged and sustained atrial fibrillation could be induced by standard programmed electrical stimulation techniques. Computerized isochronous activation maps of the atria were recorded during atrial fibrillation from 208 bipolar electrodes simultaneously. In a parallel study, human atrial fibrillation was mapped with a separate 160-channel intraoperative mapping system in patients with paroxysmal atrial fibrillation who were undergoing surgical correction of the Wolff-Parkinson-White syndrome. The canine activation sequence maps demonstrated a spectrum of rhythm abnormalities ranging from simple atrial flutter to complex atrial fibrillation. They also showed that macroreentrant circuits within the atrial myocardium were responsible for the entire spectrum of arrhythmias. Atrial reentry was also documented during human atrial fibrillation. All patients had nonuniform conduction around regions of bidirectional block in both atria resulting in multiple discrete wave fronts. In addition, six patients had a single reentrant circuit in the right atrium in which bidirectional block of the activation wave front occurred along the sulcus terminals between the venae cavae. The left atrium in all patients demonstrated multiple wave fronts and conduction block, but left atrial reentry could not be detected. Both the experimental study and the clinical study demonstrated that multiple wave fronts, nonuniform conduction, bidirectional block, and large (macroreentrant) reentrant circuits occur during atrial fibrillation. The presence of macroreentrant circuits and the absence of either microreentrant circuits or evidence of atrial automaticity suggests that atrial fibrillation should be amenable to surgical ablation.


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 Cardiovasc ResHome page
J. Jalife, O. Berenfeld, and M. Mansour
Mother rotors and fibrillatory conduction: a mechanism of atrial fibrillation
Cardiovasc Res, May 1, 2002; 54(2): 204 - 216.
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 Cardiovasc ResHome page
A. L. Waldo
Mechanisms of atrial flutter and atrial fibrillation: distinct entities or two sides of a coin?
Cardiovasc Res, May 1, 2002; 54(2): 217 - 229.
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 Cardiovasc ResHome page
A. Shimizu and O. A. Centurion
Electrophysiological properties of the human atrium in atrial fibrillation
Cardiovasc Res, May 1, 2002; 54(2): 302 - 314.
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 Cardiovasc ResHome page
T. Korte, M. Niehaus, G. Borchert, and J. Tebbenjohanns
Significant prolongation of atrial monophasic action potential duration: short-term reverse electrophysiological changes after internal cardioversion of atrial fibrillation
Cardiovasc Res, March 1, 2002; 53(4): 944 - 951.
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 CirculationHome page
V. Fuster, L. E. Ryden, R. W. Asinger, D. S. Cannom, H. J. Crijns, R. L. Frye, J. L. Halperin, G. N. Kay, W. W. Klein, S. Levy, et al.
ACC/AHA/ESC Guidelines for the Management of Patients With Atrial Fibrillation: Executive Summary A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the North American Society of Pacing and Electrophysiology
Circulation, October 23, 2001; 104(17): 2118 - 2150.
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 Eur Heart JHome page
Guidelines for the management of patients with atrial fibrillation. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to develop guidelines for the management of patients with atrial fibrillation) developed in collaboration with the North American Society of Pacing and Electrophysiology
Eur. Heart J., October 2, 2001; 22(20): 1852 - 1923.
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 J Am Coll CardiolHome page
B. Zrenner, G. Ndrepepa, M. R. Karch, M. A. E. Schneider, J.u. Schreieck, A. Schomig, and C. Schmitt
Electrophysiologic characteristics of paroxysmal and chronic atrial fibrillation in human right atrium
J. Am. Coll. Cardiol., October 1, 2001; 38(4): 1143 - 1149.
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 J Am Coll CardiolHome page
V. Fuster, L. E. Ryden, R. W. Asinger, D. S. Cannom, H. J. Crijns, R. L. Frye, J. L. Halperin, G. N. Kay, W. W. Klein, S. Levy, et al.
ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: executive summary: A Report of the American College of Cardiology/ American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the North American Society of Pacing and Electrophysiology
J. Am. Coll. Cardiol., October 1, 2001; 38(4): 1231 - 1265.
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 J Am Coll CardiolHome page
V. Fuster, L. E. Ryden, R. W. Asinger, D. S. Cannom, H. J. Crijns, R. L. Frye, J. L. Halperin, G. N. Kay, W. W. Klein, S. Levy, et al.
ACC/AHA/ESC guidelines for the management of patients with atrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines and Policy Conferences (Committee to Develop Guidelines for the Management of Patients With Atrial Fibrillation) Developed in Collaboration With the North American Society of Pacing and Electrophysiology
J. Am. Coll. Cardiol., October 1, 2001; 38(4): 1266 - 1266.
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L. Polontchouk, J.-A. Haefliger, B. Ebelt, T. Schaefer, D. Stuhlmann, U. Mehlhorn, F. Kuhn-Regnier, E. R. De Vivie, and S. Dhein
Effects of chronic atrial fibrillation on gap junction distribution in human and rat atria
J. Am. Coll. Cardiol., September 1, 2001; 38(3): 883 - 891.
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 J. Thorac. Cardiovasc. Surg.Home page
J. L. Cox
Intraoperative options for treating atrial fibrillation associated with mitral valve disease
J. Thorac. Cardiovasc. Surg., August 1, 2001; 122(2): 212 - 215.
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 HeartHome page
P A O'Callaghan, M Meara, E Kongsgaard, J Poloniecki, L Luddington, J Foran, A J Camm, E Rowland, and D E Ward
Symptomatic improvement after radiofrequency catheter ablation for typical atrial flutter
Heart, August 1, 2001; 86(2): 167 - 171.
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 Am. J. Physiol. Heart Circ. Physiol.Home page
M.-H. Lee, Z. Qu, G. A. Fishbein, S. T. Lamp, E. H. Chang, T. Ohara, O. Voroshilovsky, J. R. Kil, A. R. Hamzei, N. C. Wang, et al.
Patterns of wave break during ventricular fibrillation in isolated swine right ventricle
Am J Physiol Heart Circ Physiol, July 1, 2001; 281(1): H253 - H265.
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 Ann. Thorac. Surg.Home page
M. R. Williams, J. R. Stewart, S. F. Bolling, S. Freeman, J. T. Anderson, M. Argenziano, C. R. Smith, and M. C. Oz
Surgical treatment of atrial fibrillation using radiofrequency energy
Ann. Thorac. Surg., June 1, 2001; 71(6): 1939 - 1944.
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 Ann. Thorac. Surg.Home page
T. Sueda, K. Imai, O. Ishii, K. Orihashi, M. Watari, and K. Okada
Efficacy of pulmonary vein isolation for the elimination of chronic atrial fibrillation in cardiac valvular surgery
Ann. Thorac. Surg., April 1, 2001; 71(4): 1189 - 1193.
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 Eur Heart JHome page
J.E.P Waktare, K Hnatkova, S.M Sopher, F.D Murgatroyd, X Guo, A.J Camm, and M Malik
The role of atrial ectopics in initiating paroxysmal atrial fibrillation
Eur. Heart J., February 2, 2001; 22(4): 333 - 339.
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 J Am Coll CardiolHome page
F. Gaita, L. Calo, R. Riccardi, L. Garberoglio, M. Scaglione, G. Licciardello, L. Coda, P. Di Donna, M. Bocchiardo, D. Caponi, et al.
Different patterns of atrial activation in idiopathic atrial fibrillation: simultaneous multisite atrial mapping in patients with paroxysmal and chronic atrial fibrillation
J. Am. Coll. Cardiol., February 1, 2001; 37(2): 534 - 541.
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 Ann. Thorac. Surg.Home page
T. Sueda, K. Imai, K. Orihashi, M. Watari, and K. Okada
Pulmonary vein orifice isolation for elimination of chronic atrial fibrillation
Ann. Thorac. Surg., February 1, 2001; 71(2): 708 - 710.
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 EuropaceHome page
Z. Li, E. Hertervig, S. Yuan, Y. Yang, Z. Lin, and S. B. Olsson
Dispersion of atrial repolarization in patients with paroxysmal atrial fibrillation
Europace, January 1, 2001; 3(4): 285 - 291.
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 Cardiovasc ResHome page
J. Chen, R. Mandapati, O. Berenfeld, A. C Skanes, R. A Gray, and J. Jalife
Dynamics of wavelets and their role in atrial fibrillation in the isolated sheep heart
Cardiovasc Res, November 1, 2000; 48(2): 220 - 232.
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 ChestHome page
H. S. Friedman, M. Win, A. Hussain, and A. Sinha
Effects of Cardiac Glycosides on Atrial Contractile Dysfunction After Short-term Atrial Fibrillation
Chest, October 1, 2000; 118(4): 1116 - 1126.
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 Circ. Res.Home page
David M. Harrild, Craig S. Henriquez ;
A Computer Model of Normal Conduction in the Human Atria
Circ. Res., September 29, 2000; 87 (7): e25 - e36.
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 J Am Coll CardiolHome page
H. J. Sih, D. P. Zipes, E. J. Berbari, D. E. Adams, and J. E. Olgin
Differences in organization between acute and chronic atrial fibrillation in dogs
J. Am. Coll. Cardiol., September 1, 2000; 36(3): 924 - 931.
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 CirculationHome page
C.-F. Tsai, C.-T. Tai, M.-H. Hsieh, W.-S. Lin, W.-C. Yu, K.-C. Ueng, Y.-A. Ding, M.-S. Chang, and S.-A. Chen
Initiation of Atrial Fibrillation by Ectopic Beats Originating From the Superior Vena Cava : Electrophysiological Characteristics and Results of Radiofrequency Ablation
Circulation, July 4, 2000; 102(1): 67 - 74.
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 Eur Heart JHome page
R.J Schilling, A.H Kadish, N.S Peters, J Goldberger, and D.W. Davies
Endocardial mapping of atrial fibrillation in the human right atrium using a non-contact catheter
Eur. Heart J., April 1, 2000; 21(7): 550 - 564.
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 Ann. Thorac. Surg.Home page
A. Harada, T. Konishi, M. Fukata, K. Higuchi, T. Sugimoto, and K. Sasaki
Intraoperative map guided operation for atrial fibrillation due to mitral valve disease
Ann. Thorac. Surg., February 1, 2000; 69(2): 446 - 450.
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 Eur. J. Cardiothorac. Surg.Home page
M. B. Jatene, M. B. Marcial, F. Tarasoutchi, R. A. Cardoso, P. Pomerantzeff, and A. D. Jatene
Influence of the maze procedure on the treatment of rheumatic atrial fibrillation - evaluation of rhythm control and clinical outcome in a comparative study
Eur. J. Cardiothorac. Surg., February 1, 2000; 17(2): 117 - 124.
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 StrokeHome page
K. Berthet, T. Lavergne, A. Cohen, L. Guize, M.-G. Bousser, J.-Y. Le Heuzey, and P. Amarenco
Significant Association of Atrial Vulnerability With Atrial Septal Abnormalities in Young Patients With Ischemic Stroke of Unknown Cause
Stroke, February 1, 2000; 31(2): 398 - 403.
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 J Am Coll CardiolHome page
K. Shinagawa, H. Mitamura, A. Takeshita, T. Sato, H. Kanki, S. Takatsuki, and S. Ogawa
Determination of refractory periods and conduction velocity during atrial fibrillation using atrial capture in dogs: Direct assessment of the wavelength and its modulation by a sodium channel blocker, pilsicainide
J. Am. Coll. Cardiol., January 1, 2000; 35(1): 246 - 253.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
C. W. Hogue Jr and M. L. Hyder
Atrial fibrillation after cardiac operation: risks, mechanisms, and treatment
Ann. Thorac. Surg., January 1, 2000; 69(1): 300 - 306.
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 EuropaceHome page
M.P. Ingemansson, B. Smideberg, and S.B. Olsson
Intravenous MgSO4alone and in combination with glucose, insulin and potassium (GIK) prolong the atrial cycle length in chronic atrial fibrillation
Europace, January 1, 2000; 2(2): 106 - 114.
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 J. Thorac. Cardiovasc. Surg.Home page
J. L. Cox, N. Ad, and T. Palazzo
IMPACT OF THE MAZE PROCEDURE ON THE STROKE RATE IN PATIENTS WITH ATRIAL FIBRILLATION
J. Thorac. Cardiovasc. Surg., November 1, 1999; 118(5): 833 - 840.
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 Eur. J. Cardiothorac. Surg.Home page
V. Ducceschi, A. D'Andrea, B. Liccardo, A. Alfieri, B. Sarubbi, M. De Feo, L. Santangelo, and M. Cotrufo
Perioperative clinical predictors of atrial fibrillation occurrence following coronary artery surgery
Eur. J. Cardiothorac. Surg., October 1, 1999; 16(4): 435 - 439.
[Abstract] [Full Text] [PDF]

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 CirculationHome page
H. Sun, E. O. Velipasaoglu, D. E. Wu, H. A. Kopelen, W. A. Zoghbi, W. H. Spencer III, and D. S. Khoury
Simultaneous Multisite Mapping of the Right and the Left Atrial Septum in the Canine Intact Beating Heart
Circulation, July 20, 1999; 100(3): 312 - 319.
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 Cardiovasc ResHome page
W.-C. Yu, S.-H. Lee, C.-T. Tai, C.-F. Tsai, M.-H. Hsieh, C.-C. Chen, Y.-A. Ding, M.-S. Chang, and S.-A. Chen
Reversal of atrial electrical remodeling following cardioversion of long-standing atrial fibrillation in man
Cardiovasc Res, May 1, 1999; 42(2): 470 - 476.
[Abstract] [Full Text] [PDF]

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 J Am Coll CardiolHome page
C.-P. Lau, H.-F. Tse, and G. M. Ayers
Defibrillation-guided radiofrequency ablation of atrial fibrillation secondary to an atrial focus
J. Am. Coll. Cardiol., April 1, 1999; 33(5): 1217 - 1226.
[Abstract] [Full Text] [PDF]

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 Ann. Thorac. Surg.Home page
T. Nitta, R. Lee, R. B. Schuessler, J. P. Boineau, and J. L. Cox
Radial approach: a new concept in surgical treatment for atrial fibrillation I. Concept, anatomic and physiologic bases and development of a procedure
Ann. Thorac. Surg., January 1, 1999; 67(1): 27 - 35.
[Abstract] [Full Text] [PDF]


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