Minimally Invasive Surgical Approach to Radiofrequency Ablation of Atrial Fibrillation: Is the Game Worth the Candle?

  • C. Piorkowski
  • G. Hindricks
  • H. Kottkamp
Conference paper


Atrial fibrillation (AF) is an arrhythmia that has been shown to be associated with an elevated mortality rate and with an indipendent excess risk of stroke [1]. Long-term anticoagulation and regulation of the heart rate can only partly solve the problem, owing to the risks major bleeding [2]. In addition, many patients suffer greatly from the symptoms of AF.


Atrial Fibrillation Pulmonary Vein Chronic Atrial Fibrillation Left Atrial Appendage Mitral Valve Disease 
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  1. 1.
    Laupacis A, Cuddy TE (1996) Prognosis of individuals with atrial fibrillation. Can J Cardiol 12[Suppl A]:14A–16APubMedGoogle Scholar
  2. 2.
    Taylor FC, Cohen H, Ebrahim S (2001) Systematic review of long term anticoagulation or antiplatelet treatment in patients with non-rheumatic atrial fibrillation. BMJ 322:321–326PubMedCrossRefGoogle Scholar
  3. 3.
    Waldo AL, Van Wagoner DR (2001) Atrial fibrillation. In: Spooner PM, Rosen MR (eds) Foundations of cardiac arrhythmias. Marcel Dekker, New York, pp 479–512Google Scholar
  4. 4.
    Lewis T (1925) The mechanism and graphical registration of the heart beat, 3rd edn. Shaw and Sons, London, pp 340–342Google Scholar
  5. 5.
    Moe GK, Abildskov JA (1959) Atrial fibrillation as a self-sustained arrhytmia independent of focal discharge. Am Heart J 58:59–70PubMedCrossRefGoogle Scholar
  6. 6.
    Allessie MA, Lammers WJEP, Bonke FIM et al (1985) Experimental evaluation of Moe’s multiple wavelet hypothesis of atrial fibrillation. In: Zipes DP, Jalife J (eds) Cardiac electrophysiology and arrhythmias. Grune & Stratton, Orlando, pp 265–267Google Scholar
  7. 7.
    Haissaguerre M, Jais P, Shah DC et al (1998) Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 339:659–666PubMedCrossRefGoogle Scholar
  8. 8.
    Skane AC, Mandapati R, Berenfeld O et al (1998) Spatiotemporal periodicity during atrial fibrillation in the isolated sheep heart. Circulation 98:1236–1248CrossRefGoogle Scholar
  9. 9.
    Kumagai K, Khrestian C, Waldo AL (1997) Simultaneous multisite mapping studies during induced atrial fibrillation in the sterile pericarditis model. Circulation 95:511–521PubMedCrossRefGoogle Scholar
  10. 10.
    Cox JL, Schuessler RB, D’Agostino HJ Jr et al (1991) The surgical treatment of atrial fibrillation. Ill Development of a definite surgical procedure. J Thorac Cardiovasc Surg 101:569–583PubMedGoogle Scholar
  11. 11.
    Isobe F, Kawashima Y (1998) The outcome and indications of the Cox Maze III procedure for chronic atrial fibrillation with mitral valve disease. J Thorac Cardiovasc Surg 116:220–227PubMedCrossRefGoogle Scholar
  12. 12.
    Arcidi JM, Millar RC (1999) Evolution of the MAZE III procedure: are modifications necessary? Thorac Cardiovasc Surg 47 [Suppl]:362–364PubMedCrossRefGoogle Scholar
  13. 13.
    Kobayashi J, Kosakai Y, Nakano K et al (1998) Improved success rate of the maze procedure in mitral valve disease by new criteria for patients’ selection. Eur J Cardiothorac Surg 13:247–252PubMedCrossRefGoogle Scholar
  14. 14.
    Sueda T, Nagata H, Shikata H et al (1996) Simple left atrial procedure for chronic atrial fibrillation in patients with isolated mitral valve disease. Ann Thorac Surg 62:1796–1800PubMedCrossRefGoogle Scholar
  15. 15.
    Lee JW, Choo SJ, Kim KI et al (2001) Atrial fibrillation surgery simplified with cryoablation to improve left atrial function. Ann Thorac Surg 72:1479–1483PubMedCrossRefGoogle Scholar
  16. 16.
    Isobe F, Kumano H, Ishikawa T et al (2001) A new procedure for chronic atrial fibrillation: bilateral appendage-preserving MAZE procedure. Ann Thorac Surg 72:1473–1478PubMedCrossRefGoogle Scholar
  17. 17.
    Sueda T, Imai K, Ishii O et al (2001) Efficacy of pulmonary vein isolation for the elimination of chronic atrial fibrillation in cardiac valvular surgery. Ann Thorac Surg 71:1189–1193PubMedCrossRefGoogle Scholar
  18. 18.
    Patwardhan AM, Dave HH, Tumhane AA et al (1997) Intraoperative radiofrequency microbipolar coagulation to replace incisions of maze III procedure for correcting atrial fibrillation in patients with rheumatic valvular disease. Eur J Cardiothorac Surg 12:627–633PubMedCrossRefGoogle Scholar
  19. 19.
    Melo J, Adragao PR, Neves J et al (1999) Electrosurgical treatment of atrial fibrillation with a new intraoperative radiofrequency ablation catheter. Thorac Cardiovasc Surg 47:370–372PubMedCrossRefGoogle Scholar
  20. 20.
    Pasic M, Bergs P, Müller P et al (2001) Intraoperative radiofrequency maze ablation for atrial fibrillation: the Berlin modification. Ann Thorac Surg 72:1484–1491PubMedCrossRefGoogle Scholar
  21. 21.
    Kottkamp H, Hindricks G, Hammel D et al (1999) Intraoperative radiofrequency ablation of chronic atrial fibrillation: A left atrial curative approach by elimination of anatomic “anchor” reentrant circuits. J Cardiovasc Electrophysiol 10:772–80PubMedCrossRefGoogle Scholar
  22. 22.
    Kottkamp H, Hindricks G, Autschbach R et al (2002) Specific linear left atrial lesions in atrial fibrillation: intraoperative radiofrequency ablation using minimally invasive surgical techniques. J Am Coll Cardiol 40:475–480PubMedCrossRefGoogle Scholar
  23. 23.
    Mohr FW, Fabricius AM, Falk V et al [2002] Curative treatment of atrial fibrillation with intraoperative radiofrequency ablation: short-term and midterm results. J Thorac Cardiovasc Surg 123:919–927Google Scholar
  24. 24.
    Yu WC, Hsu TL, Tai CT et al (2001) Acquired pulmonary vein stenosis after radiofrequency ablation of paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol 12:887–892PubMedCrossRefGoogle Scholar
  25. 25.
    Schmitt C, Ndrepepa G, Weber S et al (2002) Biatrial multisite mapping of atrial premature complexes triggering onset of atrial fibrillation. Am J Cardiol 89:1381–1387PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2004

Authors and Affiliations

  • C. Piorkowski
    • 1
  • G. Hindricks
    • 1
  • H. Kottkamp
    • 1
  1. 1.Heart Center, Department of ElectrophysiologyUniversity of LeipzigGermany

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