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J Thorac Cardiovasc Surg 2001;122:212-215
© 2001 The American Association for Thoracic Surgery


Editorials

Intraoperative options for treating atrial fibrillation associated with mitral valve disease

James L. Cox, MD

Received for publication April 10, 2001. Accepted for publication April 16, 2001. Address for reprints: James L. Cox, MD, The World Heart Foundation, 1828 L St NW, Suite 1100, Washington, DC 20036.

See related article on page 249.

Atrial fibrillation is present in approximately 50% of all patients undergoing surgery for the treatment of mitral valve disease.Go Go 1-3 For more than 40 years, cardiac surgeons have been forced to ignore this associated atrial fibrillation at the time of open mitral valve surgery because there has been no effective way to treat it. After the success of the maze procedure in treating atrial fibrillation,Go Go 4-6 several surgeons began to add the maze procedure as an adjunct to mitral valve surgery to treat both problems.Go Go 7-9 When properly performed, the results with this combined approach have been excellent, with no increase in perioperative morbidity or operative mortality and with documented long-term advantages over simply leaving patients in atrial fibrillation.Go Go 8,9 Despite these results, adding the maze procedure to mitral valve surgery significantly prolongs and complicates the operation; therefore, most surgeons have understandably been reluctant to perform the combined procedure.

During the past 2 to 3 years, cardiologists have become extremely aggressive in their efforts to treat atrial fibrillation by modifications of the percutaneous radiofrequency catheters that have been so successful in treating other types of arrhythmias, especially the Wolff-Parkinson-White syndrome.Go Go 10-13 It was only a matter of time until some surgeons used these same percutaneous endocardial catheters to treat atrial fibrillation intraoperatively when performing mitral valve surgery. This new surgical intervention was quickly recognized by medical device companies as a new market and, as a result, new radiofrequency devices have been adapted specifically for intraoperative use.

In this issue of the Journal, the group from Maastricht, The Netherlands, describes the use of intraoperative radiofrequency catheters to ablate atrial fibrillation in patients who required surgery primarily for mitral valve disease. This study is particularly important because it comes from perhaps the premier electrophysiology group in the world, especially in . . . [Full Text of this Article]


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J. Thorac. Cardiovasc. Surg. 2001 122: 249-256. [Abstract] [Full Text] [PDF]



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