TY - JOUR
T1 - Left atrial ablation for atrial fibrillation
T2 - Creating the "box lesion" with a bipolar radiofrequency device
AU - Sternik, Leonid
AU - Schaff, Hartzel V.
AU - Luria, David
AU - Glikson, Michael
AU - Kogan, Alexander
AU - Malachy, Ateret
AU - First, Maya
AU - Raanani, Ehud
PY - 2011
Y1 - 2011
N2 - The maze procedure is the gold standard for the ablation of atrial fibrillation, and the "box lesion" around the pulmonary veins is the most important part of this procedure. We have created this lesion with a bipolar radiofrequency ablator, abandoning the usual use of this device (to achieve bilateral epicardial isolation of the pulmonary veins). From March 2004 through the end of May 2010, we performed surgical ablation of atrial fibrillation in 240 patients. Of this number, 205 underwent operation by a hybrid maze technique and the remaining 35 (our study cohort) underwent the creation of a box lesion around the pulmonary veins by means of a bipolar radiofrequency device. Ablation lines were created by connecting the left atriotomy to the amputated left atrial appendage, with 2 ablation lines made with a bipolar radiofrequency device above and below the pulmonary veins. Lesions were made along the transverse and oblique sinuses by epicardial and endocardial application of a bipolar device. The left atrial isthmus was ablated by bipolar radiofrequency and cryoprobe. No complications were associated with the box lesion: 90% and 89% of patients were in sinus rhythm at 3 and 6 months of follow-up, respectively. By creating a box lesion around the pulmonary veins, we expect to improve transmurality by means of epicardial and endocardial ablation of 1 rather than 2 layers of atrial wall, as in epicardial pulmonary vein isolation. Isolation of the entire posterior wall of the left atrium is better electrophysiologically and renders dissection around the pulmonary veins unnecessary.
AB - The maze procedure is the gold standard for the ablation of atrial fibrillation, and the "box lesion" around the pulmonary veins is the most important part of this procedure. We have created this lesion with a bipolar radiofrequency ablator, abandoning the usual use of this device (to achieve bilateral epicardial isolation of the pulmonary veins). From March 2004 through the end of May 2010, we performed surgical ablation of atrial fibrillation in 240 patients. Of this number, 205 underwent operation by a hybrid maze technique and the remaining 35 (our study cohort) underwent the creation of a box lesion around the pulmonary veins by means of a bipolar radiofrequency device. Ablation lines were created by connecting the left atriotomy to the amputated left atrial appendage, with 2 ablation lines made with a bipolar radiofrequency device above and below the pulmonary veins. Lesions were made along the transverse and oblique sinuses by epicardial and endocardial application of a bipolar device. The left atrial isthmus was ablated by bipolar radiofrequency and cryoprobe. No complications were associated with the box lesion: 90% and 89% of patients were in sinus rhythm at 3 and 6 months of follow-up, respectively. By creating a box lesion around the pulmonary veins, we expect to improve transmurality by means of epicardial and endocardial ablation of 1 rather than 2 layers of atrial wall, as in epicardial pulmonary vein isolation. Isolation of the entire posterior wall of the left atrium is better electrophysiologically and renders dissection around the pulmonary veins unnecessary.
KW - Atrial fibrillation/surgery
KW - Catheter ablation/methods
KW - Heart atria/surgery
KW - Heart conduction system/surgery
KW - Maze procedure
KW - Pulmonary veins/surgery
KW - Retrospective studies
KW - Treatment outcome
UR - http://www.scopus.com/inward/record.url?scp=79955100559&partnerID=8YFLogxK
M3 - מאמר
AN - SCOPUS:79955100559
VL - 38
SP - 127
EP - 131
JO - Texas Heart Institute Journal
JF - Texas Heart Institute Journal
SN - 0730-2347
IS - 2
ER -