Document Detail

Initial experience with the radial incision approach for atrial fibrillation.
MedLine Citation:
PMID:  10509966     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Surgery for atrial fibrillation (AF) is performed with the aim of restoring sinus rhythm and atrial transport function, and preventing thromboembolism. The radial incision approach (RIA), in which the atrial incisions radiate from the sinus node toward the atrioventricular annular margins and parallel the coronary arteries, was developed as an outgrowth of and an alternative to the maze procedure in order to preserve a more physiological activation sequence and the atrial transport function. METHODS: To determine whether the RIA is a promising procedure for AF, 23 patients who had undergone the RIA (n = 10) or the maze procedure (n = 13) for chronic AF associated with valvular heart disease were examined in terms of the postoperative cardiac rhythm and atrial transport function. RESULTS: AF was cured in 90% of RIA patients and 92.3% of maze patients (not significant). One patient in each group required pacemaker implantation for an insufficient sinus rate postoperatively. The RIA was technically easier than the maze procedure, because the incisions were more linear and there was no isolation incision or "T-shape" incision in the left atrium. The left atrial transport function, assessed by transthoracic Doppler echocardiography, was greater after the RIA than after the maze procedure, while the right atrial transport function was equally preserved by both procedures. The peak atrial filling/early filling waves of the flow-velocity spectra across the mitral valve was significantly larger after the RIA than after the maze procedure (0.58+/-0.17 vs. 0.25+/-0.07, p<0.005). The left atrial filling fraction was significantly larger after the RIA than after the maze procedure (28.5%+/-5.0% vs. 15.1%+/-4.0%, p<0.001). CONCLUSIONS: RIA provides a greater atrial transport function, and thus may represent a physiological alternative to the maze procedure as a surgical procedure for AF.
T Nitta; Y Ishii; H Ogasawara; S Sakamoto; Y Miyagi; K Yamada; S Kanno; S Tanaka
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  68     ISSN:  0003-4975     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  1999 Sep 
Date Detail:
Created Date:  1999-10-15     Completed Date:  1999-10-15     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  805-10; discussion 811     Citation Subset:  AIM; IM    
Department of Cardiothoracic Surgery, Nippon Medical School, Tokyo, Japan. nitta_takashi/
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MeSH Terms
Atrial Fibrillation / etiology,  physiopathology,  surgery*,  ultrasonography
Atrial Function
Cardiac Surgical Procedures / methods
Chronic Disease
Echocardiography, Doppler
Heart Rate
Heart Valve Diseases / complications
Middle Aged
Pacemaker, Artificial

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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