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J Thorac Cardiovasc Surg 2003;126:1693-1699
© 2003 The American Association for Thoracic Surgery

Editorial

Atrial fibrillation II: rationale for surgical treatment

^a Division of Cardiothoracic Surgery, Washington University School of Medicine, St Louis, Mo, USA

Received for publication May 31, 2003; accepted for publication June 9, 2003.

^* Address for reprints: James L. Cox, MD, 13523 Rosewood Ln, Naples, FL 34119, USA
jamescoxmd@aol.com

The first 300 words of the full text of this article appear below.

All surgical procedures for cardiac arrhythmias can be classified as either isolation procedures or ablation procedures. Isolation procedures do not actually terminate arrhythmias but rather confine them, their trigger mechanisms, or both to a desired region of the heart to minimize their adverse effects. Examples of isolation procedures include the following:

1. elective His bundle ablation for any type of supraventricular tachycardia, which confines the supraventricular tachycardia to the atria;
   
2. the left atrial isolation procedure for automatic left atrial tachycardias and atrial fibrillation, which confines the tachycardia or fibrillation to the left atrium;
   
3. the right atrial isolation procedure for automatic right atrial tachycardias, which confines the tachycardia to the right atrium;
   
4. the corridor procedure for atrial fibrillation, which confines the fibrillation to the atria and isolates it from the atrioventricular node;
   
5. the right ventricular isolation procedure for nonischemic ventricular tachycardia, which confines the tachycardia to the right ventricle; and
   
6. pulmonary vein isolation for intermittent atrial fibrillation, which confines the trigger for atrial fibrillation to the pulmonary veins.
   

Ablation procedures preclude arrhythmias from developing either by destroying their trigger mechanism or by altering (or removing) the substrate that allows the arrhythmia to be induced and maintained. Ablative procedures include the following:

1. surgical intervention for the Wolff-Parkinson-White syndrome, which interrupts the macroreentrant circuit responsible for the tachycardia;
   
2. discrete cryosurgery for atrioventricular node reentry tachycardia, which interrupts the microreentrant circuit responsible for the tachycardia;
   
3. focal cryoablation for automatic atrial tachycardias, which destroys the trigger mechanism responsible for the tachycardia;
   
4. endocardial resection procedures for ischemic ventricular tachycardia, which removes the microreentrant circuit responsible for the tachycardia;
   
5. endocardial cryosurgical procedures for ischemic ventricular tachycardia, which destroys the microreentrant circuit responsible for the tachycardia; and
   
6. the maze procedure for atrial fibrillation, which destroys the macroreentrant circuits responsible for atrial fibrillation.
   

The ultimate effect of any cardiac surgical . . . [Full Text of this Article]

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