Document Detail

Left atrial ablation for atrial fibrillation: creating the "box lesion" with a bipolar radiofrequency device.
MedLine Citation:
PMID:  21494518     Owner:  NLM     Status:  MEDLINE    
The maze procedure is the gold standard for the ablation of atrial fibrillation, and the "box lesion" around the pulmonary veins is the most important part of this procedure. We have created this lesion with a bipolar radiofrequency ablator, abandoning the usual use of this device (to achieve bilateral epicardial isolation of the pulmonary veins).From March 2004 through the end of May 2010, we performed surgical ablation of atrial fibrillation in 240 patients. Of this number, 205 underwent operation by a hybrid maze technique and the remaining 35 (our study cohort) underwent the creation of a box lesion around the pulmonary veins by means of a bipolar radiofrequency device. Ablation lines were created by connecting the left atriotomy to the amputated left atrial appendage, with 2 ablation lines made with a bipolar radiofrequency device above and below the pulmonary veins. Lesions were made along the transverse and oblique sinuses by epicardial and endocardial application of a bipolar device. The left atrial isthmus was ablated by bipolar radiofrequency and cryoprobe. No complications were associated with the box lesion: 90% and 89% of patients were in sinus rhythm at 3 and 6 months of follow-up, respectively.By creating a box lesion around the pulmonary veins, we expect to improve transmurality by means of epicardial and endocardial ablation of 1 rather than 2 layers of atrial wall, as in epicardial pulmonary vein isolation. Isolation of the entire posterior wall of the left atrium is better electrophysiologically and renders dissection around the pulmonary veins unnecessary.
Leonid Sternik; Hartzel V Schaff; David Luria; Michael Glikson; Alexander Kogan; Ateret Malachy; Maya First; Ehud Raanani
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital     Volume:  38     ISSN:  1526-6702     ISO Abbreviation:  Tex Heart Inst J     Publication Date:  2011  
Date Detail:
Created Date:  2011-04-15     Completed Date:  2011-08-09     Revised Date:  2013-06-30    
Medline Journal Info:
Nlm Unique ID:  8214622     Medline TA:  Tex Heart Inst J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  127-31     Citation Subset:  IM    
Department of Cardiac Surgery, Chaim Sheba Medical Center, Tel Hashomer 52621, Israel.
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MeSH Terms
Atrial Appendage / surgery
Atrial Fibrillation / physiopathology,  surgery*
Catheter Ablation / adverse effects,  instrumentation*
Equipment Design
Middle Aged
Pulmonary Veins / physiopathology,  surgery*
Retrospective Studies
Time Factors
Treatment Outcome

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

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