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J Thorac Cardiovasc Surg 2005;129:1-4
© 2005 The American Association for Thoracic Surgery

Editorials

The central controversy surrounding the interventional-surgical treatment of atrial fibrillation

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

Received for publication August 26, 2004; accepted for publication August 30, 2004.

^* Address for reprints, James L. Cox, MD, 13523 Rosewood Lane, Naples, FL 34119 (E-mail: jamescoxmd@aol.com).

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

In this issue of the Journal, Fasol and colleagues¹ from Vienna describe their technique for ablating atrial fibrillation in association with mitral valve surgery by creating a triangular pattern of lesions endocardially in the left atrium using irrigated unipolar radiofrequency. The triangular lesion pattern is described in the text as encompassing the orifices of the 4 pulmonary veins, with one corner of the triangle extending down to the mitral valve annulus. However, in Figure 1 the triangle does not include the orifices of the right pulmonary veins. In addition, in the legend for Figure 1, the authors state that the triangle also encompasses the closed orifice of the unresected left atrial appendage, although the figure itself clearly shows the closed appendage orifice to be outside the confines of the triangle. Thus, it is unclear where the triangle is located from reading the text and then observing Figure 1. Nevertheless, assuming that the triangle encompasses all 4 pulmonary vein orifices, regardless of whether it includes the closed orifice of the left atrial appendage, this lesion pattern is clearly simpler than that of the classic maze procedure, as the authors correctly state. However, several questions are left unanswered by the authors that affect the potential significance of their study.

The 10 patients in this study are described as having had "chronic atrial fibrillation." Other than noting that the atrial fibrillation had been "... preexisting for longer than 6 months," the authors do not clarify whether the term "chronic" refers to the duration of the arrhythmia or to the fact that it was continuously present in these patients. If "chronic" refers to the duration of the arrhythmia, and the patients were not in continuous atrial fibrillation, they were, by definition, having recurrent bouts of paroxysmal (intermittent) atrial fibrillation. In that case the . . . [Full Text of this Article]

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