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J Thorac Cardiovasc Surg 2006;131:949-951
© 2006 The American Association for Thoracic Surgery

Editorial

Surgery for atrial fibrillation: Are we heading in the right direction?

Faculdade de Ciências Médicas, Hospital de Santa Cruz, Carnaxide, Portugal.

Received for publication December 17, 2005; accepted for publication December 29, 2005.

^_* Address for reprints: Faculdade de Ciências Médicas, Hospital de Santa Cruz, AV Prof Dr Reinaldo dos Santos, 2790-134 Carnaxide, Portugal.

The first 20% of the full text of this article appears below.

Atrial fibrillation surgery has become an area of major interest for cardiac surgeons. This is not surprising, because there is increasing information showing that surgery should play a larger role in the therapeutic armamentarium of this enigmatic syndrome, or primary disease. Starting in 1980, Williams and colleagues ¹ and Defauw and colleagues ² proposed 2 surgical techniques, isolation of the left atrium and the corridor procedure, respectively, to obtain rate control of this difficult and complex pathology.

In 1991, Cox and colleagues ^3,4 described the maze 1 operation and later the maze 2 and maze 3 operations. These techniques were the first attempts to surgically achieve a rhythm-control therapy for atrial fibrillation, and the maze 3 became the gold standard for surgical treatment of atrial fibrillation. Because the maze 3 is a complex operation, requiring a long ischemic time and having a major potential for bleeding, it never became a widespread technique.

With a completely different approach based on information from Hannover, ⁵ in 1998 our group was the first to describe the surgical treatment of permanent atrial fibrillation using bilateral isolation of the pulmonary veins ⁶ in patients with mitral valve disease, by using endocardial radiofrequency catheter ablation. The concept behind this approach is to avoid macroreentry, which inside the left atrium is mostly occurring around the ostia of the pulmonary veins, where refractory periods are much shorter than in the cavity of the left atrium. ⁷ Cox and colleagues ⁸ state that "atrial fibrillation ... could come from the PV but they were not mapped."

Concomitantly and independently, Haissaguerre and colleagues ⁹ described ectopic foci within the pulmonary veins as the origin of lone atrial fibrillation in some patients with paroxysmal lone atrial fibrillation, and reported very high early success rates.

The suboptimal results we reported initially were obtained . . . [Full Text of this Article]

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