RT-92
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Antiarrhythmic surgery for
treatment of atrial fibrillation
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Hans Kottkamp, Gerhard Hindricks,
Dieter Hammel, Jörg Mergenthaler, Martin Borggrefe, Hans H. Scheld, Günter Breithardt.
Hospital of the Westfälische Wilhelms-University, Department of Cardiology and
Angiology, Institute for Arteriosclerosis Research, Münster, Germany
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Introduction
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Atrial fibrillation is a common cardiac arrhythmia
that kept physicians and scientists busy for more than 150 years and still continues to do
so. At present, atrial fibrillation is again under intensive experimental and clinical
investigation for different reasons: first, the development of simultaneous multisite
high-density mapping allows the investigation of the electrophysiology of atrial
fibrillation in more detail beyond the so-called multiple wavelet hypothesis that has been
initially described by Moe1. A further understanding of
the pathophysiological nature of atrial fibrillation from the ionic channel basis to the
delineation of the different sorts of atrial reentry patterns will certainly have
implications for the treatment of atrial fibrillation. Second, a clinically established
curative treatment strategy for atrial fibrillation with widespread application is still
missing. Most patients with atrial fibrillation are currently treated with antiarrhythmic
drugs that try either to prevent recurrences of atrial fibrillation or to control the
ventricular rate during ongoing atrial fibrillation. Ineffectiveness, intolerance or
potentially life-threatening proarrhythmic side effects, however, limit the benefit of
antiarrhythmic drug treatment strategies. Therefore, intraoperative2-8
and percutaneous transcatheter9-11 curative treatment
modalities are currently under intensive investigation. Third, atrial fibrillation is of
paramount importance for our health care system from a socioeconomic standpoint because
atrial fibrillation is the most common sustained cardiac arrhythmia and results in a
significant morbidity and mortality. In this chapter, the different approaches for atrial
fibrillation surgery are described and a new method of intraoperative radiofrequency
current application for induction of long linear contiguous lesions is introduced.
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Key Words
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Cardiac surgery – arrhythmias
atrial fibrillation, mitral valve disease, left atrial isolation, Maze operation, OA
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