scholarly journals What is the true (unbiased) percentage freedom from atrial fibrillation at 6 months after the modified Cox maze procedure using bipolar radiofrequency energy?

2005 ◽  
Vol 129 (2) ◽  
pp. 477
Author(s):  
Eric Lim ◽  
Stephen Large
Keyword(s):  
Atrial Fibrillation ◽  
Maze Procedure ◽  
Radiofrequency Energy ◽  
Bipolar Radiofrequency

The Mei mini-maze procedure

2020 ◽  
Vol 28 (7) ◽  
pp. 416-420
Author(s):  
Zhaolei Jiang ◽  
Nan Ma ◽  
Min Tang ◽  
Hao Liu ◽  
Shiao Ding ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Maze Procedure ◽  
Surgical Trauma ◽  
High Morbidity ◽  
Radiofrequency Energy ◽  
Thoracoscopic Approach ◽  
Left Chest ◽  
Video Assisted ◽  
Left Pulmonary Vein ◽  
The Right

Atrial fibrillation is a common clinical arrhythmia with high morbidity and a risk of stroke. The Cox-maze IV procedure that uses radiofrequency energy for ablation is established as an effective way to eliminate atrial fibrillation. Compared to the Cox-maze IV procedure, the video-assisted Wolf mini-maze procedure is associated with reduced surgical trauma, but still requires bilateral thoracotomies, and the ablation line connecting the right and left pulmonary vein isolations cannot be created with a bipolar ablation clamp. We have developed a novel video-assisted mini-maze technique that uses a unilateral (left chest) thoracoscopic approach (the Mei mini-maze procedure).

Minimally Invasive Surgery Using Bipolar Radiofrequency Energy Is Effective Treatment for Refractory Atrial Fibrillation

2012 ◽  
Vol 93 (5) ◽  
pp. 1456-1461 ◽  
Author(s):  
Vigneshwar Kasirajan ◽  
Elizabeth A. Spradlin ◽  
Tammy E. Mormando ◽  
Angel E. Medina ◽  
Phillip Ovadia ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Minimally Invasive Surgery ◽  
Minimally Invasive ◽  
Effective Treatment ◽  
Invasive Surgery ◽  
Radiofrequency Energy ◽  
Bipolar Radiofrequency

scholarly journals An off-pump biatrial mini-maze procedure for treatment of long-standing persistent atrial fibrillation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
T Yan ◽  
S.J Zhu ◽  
M Zhu ◽  
C.F Guo
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Vena Cava ◽  
Persistent Atrial Fibrillation ◽  
Maze Procedure ◽  
Purse String ◽  
Off Pump ◽  
Bipolar Radiofrequency ◽  
The Right

Abstract Background Surgical treatment has assumed a more prominent role in the therapy of atrial fibrillation (AF) with favorable efficiency and acceptable safety during the last decades. The traditional Cox-Maze procedure and Wolf Mini-Maze procedure focused on left atrial ablation. However, it is ubiquitous that patients with long-standing persistent atrial fibrillation (LSPAF) typically suffer from biatrial electrical and structural remodeling. The left atrial procedures are still not enough in patients with LSPAF. Purpose Herein, we aimed to introduce a modified biatrial off-pump ablation procedure based on the Wolf Mini-Maze procedure and to detect the safety and efficacy of the surgery for patients with LSPAF. Methods Between January 2016 and September 2020, 102 patients of LSPAF underwent our modified Mini-Maze procedure using bipolar radiofrequency ablation. Those patients firstly underwent a Mini-Maze procedure using Dallas lesion set, including video-assisted bilateral mini-thoracotomy, left atrial appendage excision, bilateral pulmonary vein isolation, ganglionic plexi evaluation and destruction, left atrial roof connecting lesion, and a linear lesion connecting this roofline to the root of the aorta at the junction of the left coronary and the non-coronary cusp. Secondly, a purse-string suture was performed on the right atrium, and then four ablation lesions were made to the superior vena cava, to the inferior vena cava, to the appendix of the right atrium, and to the tricuspid valve annulus from the purse-string suture point by the bipolar radiofrequency clamp. After the operation, the patients were followed up at an interval of 3, 6, 12 months, and every 1 year after that. Results No mortality No surgical re-exploration for bleeding. No permanent pacemaker implantation. 99 patients were free from LSPAF upon discharge. A follow-up at interval of 3, 6, 12, 24, 36, and 48 months showed a success rate free from LSPAF was 95.1% (97/102), 94.4% (85/90), 94.8% (73/77), 91.5% (54/59), 90.3% (28/31) and 100% (9/9), respectively Conclusions The modified biatrial Mini-Maze suggested a safe and feasible procedure. Early follow-up demonstrated an acceptable success rate free from AF. It might have the potential to become another option for clinical treatment of LSPAF. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): General Program of the National Natural Science Foundation of China Schematic of the procedure

scholarly journals A Minimally Invasive Cox-Maze Procedure Operative Technique and Results

2010 ◽  
Vol 5 (4) ◽  
pp. 281-286 ◽  
Author(s):  
Anson M. Lee ◽  
Kal Clark ◽  
Marci S. Bailey ◽  
Abdulhameed Aziz ◽  
Richard B. Schuessler ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Antiarrhythmic Drugs ◽  
Median Sternotomy ◽  
Invasive Procedure ◽  
Holter Monitoring ◽  
Maze Procedure ◽  
Radiofrequency Energy ◽  
Bipolar Radiofrequency ◽  
Antiarrhythmic Medications ◽  
Mini Thoracotomy

Objective The Cox-Maze procedure (CMP) for the surgical treatment of atrial fibrillation (AF) traditionally has required a median sternotomy and cardiopulmonary bypass. This study describes a method using ablation technologies to create the full Cox-Maze lesion set through a 5- to 6-cm right minithoracotomy. Methods Twenty-two consecutive patients underwent a CMP through a right mini-thoracotomy and cardiopulmonary bypass. All patients were followed prospectively with electrocardiogram and 24-hour Holter monitoring at 3, 6, and 12 months. The CMP lesion set was created using bipolar radiofrequency energy and cryotherapy. Results There was no operative mortality or major complications. Two patients required a permanent pacemaker. Five patients (23%) had early atrial tachyarrhythmias. At last follow-up (mean, 18 ± 12 months), all the patients (n = 22) were free from atrial dysrhythmias. At 3 months (n = 19), 84% of patients were off antiarrhythmic drugs. At 6 months (n = 18), 94% of patients were free from AF and off antiarrhythmic medications. At 12 months (n = 16), 81% of patients were free from AF and off antiarrhythmic drugs and three patients remained on warfarin for a mechanical mitral valve. Conclusions A full CMP can be performed through a right mini-thoracotomy with outstanding short-term results. This less invasive procedure can be offered to patients without compromising efficacy.

Electrophysiological findings after bilateral thoracoscopic atrial fibrillation ablation using irrigated bipolar radiofrequency energy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
T Skala ◽  
O Moravec ◽  
P Santavy ◽  
A Steriovsky ◽  
M Taborsky
Keyword(s):  
Atrial Fibrillation ◽  
Public Hospital ◽  
Pulmonary Veins ◽  
University Hospital ◽  
Funding Source ◽  
Radiofrequency Energy ◽  
Bipolar Radiofrequency ◽  
Electrophysiological Findings ◽  
Af Recurrence

Abstract Background Thoracoscopic atrial fibrillation (AF) ablation (TARAFS) using irrigated bipolar radiofrequency energy should result in posterior left atrial (LA) wall isolation. Purpose To assess the long-term durability of this “box” lesion and the extent of additional ablation needed to achieve AF non-inducibility. Methods 22 patients with AF recurrence after bilateral TARAFS for persistent AF had a radiofrequency catheter ablation (RFA) at least three months after TARAFS. Electroanatomical voltage map was done in all patients prior to any ablation. Results Out of 22 patients, the box lesion was not completed in 15 (68.2%). In these 15 patients, 12 had no signs of any prior ablation in endocardium (voltage >0.5mV), 2 had right pulmonary veins (PVs) isolated and 1 had left PVs isolated. At the end of RFA, box lesion was finished in all 15 patients and AF non-inducibility was achieved in 18 patients. For this endpoint, besides box lesion, mitral line and extensive coronary sinus ablation was necessary in 14, extensive CFAE ablation in 7 patients. Cavotricuspid isthmus line block was done in all patients. Conclusion A minimally invasive thoracoscopic box-lesion ablation is considered to be a safe and effective method of stand-alone AF treatment. However, in a considerable amount of patients no signs of prior ablation are found on electroanatomical voltage map. Gaps thus cannot be found and a completely new complex ablation must be done. In a lot of patients, additional ablation is needed besides box lesion to achieve non-inducibility. Funding Acknowledgement Type of funding source: Public hospital(s). Main funding source(s): University Hospital Olomouc

Epicardial, Biatrial Ablation with Integrated Uni-Bipolar Radiofrequency Technology in Stand-Alone Persistent Atrial Fibrillation

2018 ◽  
Vol 13 (2) ◽  
pp. 114-119 ◽  
Author(s):  
Fabrizio Rosati ◽  
Claudio Muneretto ◽  
Elisa Merati ◽  
Gianluca Polvani ◽  
Massimo Moltrasio ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Surgical Treatment ◽  
Minimally Invasive ◽  
Sinus Rhythm ◽  
Left Atrial ◽  
Persistent Atrial Fibrillation ◽  
Right Atrial ◽  
Radiofrequency Energy ◽  
Invasive Approach ◽  
Bipolar Radiofrequency

Objective Although minimally invasive approaches for surgical treatment of stand-alone atrial fibrillation have gained popularity for the past decade, ablation technology and extensive lesion sets play a major role in the achievement of a successful procedure, especially in presence of persistent and long-standing persistent atrial fibrillation. We evaluated clinical outcomes after totally endoscopic biatrial epicardial ablation of persistent atrial fibrillation with a novel integrated uni-bipolar radiofrequency device. Methods Forty-nine (49) consecutive patients with stand-alone atrial fibrillation underwent right-sided monolateral thoracoscopic surgical ablation with a novel integrated uni-bipolar radiofrequency energy delivery and temperature-controlled technology. Atrial fibrillation was persistent in 13 (26.5%) of 49 and long-standing persistent in 36 (73.5%) of 49 patients. Mean ± SD age was 60.6 ± 10.3 years. Median duration of atrial fibrillation was 74 months. Mean ± SD left atrial diameter was 44.7 ± 4.0 mm. Results Epicardial en bloc isolation of all pulmonary veins (box lesion) and additional ablation of the right atrial free wall was successfully performed via minimally invasive approach without any intraoperative and postoperative major complications. Intraoperative entrance and exit block was achieved in 77.5% (38/49) and 91.8% (45/49) of patients, respectively. Mean ± SD ablation time was 16.3 ± 4.8 minutes. No intensive care unit stay was required. Postoperative sinus rhythm was achieved in 93.8% (30/32) patients, and no pacemaker implantation was required. At 13 months, 87.7% (43/49) of patients were in sinus rhythm; 71.4% (35/49) were free from antiarrhythmic drugs and 75.5% (37/49) from oral anticoagulation. Conclusions Integrated uni-bipolar radiofrequency ablation technology showed to be effective for the surgical treatment of atrial fibrillation with a total endoscopic approach. A versapolar suction device with extensive right-left atrial lesion set may further improve outcomes in patients with nonparoxysmal atrial fibrillation.

scholarly journals Modified mini-maze via left thoracic cavity under VATS for paroxysmal atrial fibrillation in a patient with complete interruption of the inferior vena cava

2021 ◽  
Author(s):  
Fan He ◽  
Bijun Xu ◽  
Shiqiang Wang ◽  
Huai-Dong Chen ◽  
Weimin Zhang
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Inferior Vena Cava ◽  
Left Atrium ◽  
Inferior Vena ◽  
Vena Cava ◽  
Maze Procedure ◽  
Thoracic Cavity ◽  
Left Chest ◽  
Bipolar Radiofrequency

Objectives: We sought to determine the technical feasibility of surgical bipolar radiofrequency ablation (endoscopic maze procedure) through the left chest cavity in patients with an interrupted inferior vena cava (IVC). Methods and Results: A 57-year-old female with paroxysmal atrial fibrillation (AF) and an interrupted IVC was referred to our hospital for radiofrequency ablation. Transseptal puncture and left atrium (LA) ablation failed through a standard IVC approach via the femoral vein due to intrahepatic interruption of IVC. We performed a modified surgical bipolar radiofrequency ablation (RF) on the beating heart through 3 ports in the left chest wall. Pulmonary vein isolation and ablation of the left atrium were achieved by bipolar radiofrequency ablation. Ganglionic plexus ablation was completed using the ablation pen. The left atrial appendage was excluded. No complications occurred during or after the procedure. The patient was discharged with sinus rhythm 3 days later after the procedure. She was taking amiodarone (100mg bid) within 6 months after the procedure, and had no recurrence of AF. Conclusions: We successfully performed a modified mini-maze procedure in a patient with paroxysmal AF and IVC interruption through the left thoracic cavity under video-assisted thoracoscopic surgery (VATS). We can successfully complete pulmonary vein (PV) isolation, left atrium box isolation, cardiac ganglia ablation, Marshall ligament ablation, and coronary sinus epicardium ablation using this technique.

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