HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Takashi Nitta Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Nitta, T. Articles by Shimizu, K. Search for Related Content PubMed PubMed Citation Articles by Nitta, T. Articles by Shimizu, K. Related Collections Electrophysiology - arrhythmias

J Thorac Cardiovasc Surg 2005;129:291-299
© 2005 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Map-guided surgery for atrial fibrillation

Department of Cardiothoracic Surgery, Nippon Medical School, Tokyo, Japan

Read at the Eighty-fourth Annual Meeting of The American Association for Thoracic Surgery, Toronto, Ontario, Canada, April 25-28, 2004.

Received for publication May 11, 2004; revisions received September 5, 2004; accepted for publication September 20, 2004.

^* Address for reprints: Takashi Nitta, MD, Cardiothoracic Surgery, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan (E-mail: nitta{at}nms.ac.jp).

BACKGROUND: Although current surgical procedures result in a high success rate for atrial fibrillation, they are not guided by electrophysiologic findings in individual patients and thus might include unnecessary incisions in some patients or be inappropriate for other patients. We sought to determine whether intraoperative mapping is beneficial for the surgical treatment of atrial fibrillation.

METHODS: A 256-channel 3-dimensional dynamic mapping system with custom-made epicardial patch electrodes was used to examine the atrial activation during atrial fibrillation and to determine the optimal procedure in 37 patients with continuous and 9 patients with intermittent atrial fibrillation intraoperatively.

RESULTS: Surgical intervention for atrial fibrillation was not indicated in 3 patients in whom the atrial electrograms had a low voltage over a broad area. Concurrent, multiple, and repetitive activations arising from the pulmonary veins or left atrial appendage were observed in all patients. A simple left atrial procedure consisting of pulmonary vein isolation and left atrial incisions without any right atrial incisions was performed in 8 patients in whom the right atrial activation was passive, and all (100%) were cured of atrial fibrillation. The radial procedure was performed in the remaining 35 patients, and 31 (89%) of the patients were cured of atrial fibrillation. In this subset of patients, 10 exhibited reentrant or focal activation in the posterior left atrium between the right and left pulmonary veins and required an additional linear ablation on the posterior left atrium. The total amount of postoperative bleeding after the simple left atrial procedure was significantly less than after the radial procedure (378 ± 135 vs 711 ± 364 mL, P = .03). The right and left atrial transport functions were well preserved after both the radial and simple left atrial procedures.

CONCLUSION: Intraoperative mapping facilitates determining the optimal procedure for atrial fibrillation in each patient.

This article has been cited by other articles:

				T. Nitta, J. Kurita, H. Murata, H. Ohmori, S.-i. Sakamoto, M. Ochi, and K. Shimizu Intraoperative Electroanatomic Mapping Ann. Thorac. Surg., April 1, 2012; 93(4): 1285 - 1288. [Abstract] [Full Text] [PDF]

				D. Tamborero, L. Mont, A. Berruezo, M. Matiello, B. Benito, M. Sitges, B. Vidal, T. M. de Caralt, R. J. Perea, R. Vatasescu, et al. Left Atrial Posterior Wall Isolation Does Not Improve the Outcome of Circumferential Pulmonary Vein Ablation for Atrial Fibrillation: A Prospective Randomized Study Circ Arrhythm Electrophysiol, February 1, 2009; 2(1): 35 - 40. [Abstract] [Full Text] [PDF]

				S. Fukunaga, H. Hori, T. Ueda, K. Takagi, E. Tayama, and S. Aoyagi Effect of Surgery for Atrial Fibrillation Associated With Mitral Valve Disease Ann. Thorac. Surg., October 1, 2008; 86(4): 1212 - 1217. [Abstract] [Full Text] [PDF]

				R. K. Voeller, R. B. Schuessler, and R. J. Damiano Jr. Surgical Treatment of Atrial Fibrillation , January 1, 2008; 3(2008): 1375 - 1394. [Full Text]

				A. M. Gillinov Choice of Surgical Lesion Set: Answers From the Data Ann. Thorac. Surg., November 1, 2007; 84(5): 1786 - 1792. [Abstract] [Full Text] [PDF]

				P. Sanders, M. Hocini, P. Jais, F. Sacher, L.-F. Hsu, Y. Takahashi, M. Rotter, T. Rostock, C. J. Nalliah, J. Clementy, et al. Complete isolation of the pulmonary veins and posterior left atrium in chronic atrial fibrillation. Long-term clinical outcome Eur. Heart J., August 1, 2007; 28(15): 1862 - 1871. [Abstract] [Full Text] [PDF]

				D. Kim, K. Kim, Y.-H. Lee, and H. Ahn Detection of atrial arrhythmia in superconducting quantum interference device magnetocardiography; preliminary result of a totally-noninvasive localization method for atrial current mapping Interact CardioVasc Thorac Surg, June 1, 2007; 6(3): 274 - 279. [Abstract] [Full Text] [PDF]

				G. Shanmugam Atrial fibrillation: Isolation or ablation? J. Thorac. Cardiovasc. Surg., July 1, 2005; 130(1): 233 - 234. [Full Text] [PDF]