Atrial Fibrillation Surgery
A 65 year-old gentleman presented with a progressive history of increasing exertional dyspnoea, associated with frequent palpitations. He had no previous history of rheumatic fever or infective endocarditis but had been diagnosed with atrial fibrillation 6 months previously. Medical management included amiodarone therapy and an electrical cardioversion, which had failed to provide sustained freedom from the atrial arrhythmia. In view of this, he was also being managed with warfarin anti-coagulation therapy. His electrocardiogram had shown absence of P waves and an irregular ventricular response, consistent with his atrial fibrillation (Fig. 18.1). Cardiac catheterisation had demonstrated no obstructive coronary artery disease. Trans-thoracic and trans-oesophageal echocardiography had revealed an anterior directed jet of severe mitral regurgitation caused by prolapse of the posterior mitral valve leaflet, dilated left atrium (diameter 5.64 cm), enlarged left ventricle (left ventricular end-diastolic diameter 6.1 cm) and some impairment of left ventricular function (ejection fraction 48%).
KeywordsAtrial fibrillation Ablation Pulmonary vein isolation Posterior left atrial box lesion set Cox-maze IV procedure Focal areas of automaticity Thromboembolism Macro re-entry circuits Bipolar radiofrequency ablation Cryoablation Left atrial appendage excision
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