TY  - CHAP
M1  - Book, Section
TI  - Surgical Therapies for Atrial Fibrillation
A1  - Weimar, Timo
A1  - Damiano, Ralph J.
A2  - Yuh, David D.
A2  - Vricella, Luca A.
A2  - Yang, Stephen C.
A2  - Doty, John R.
PY  - 2014
T2  - Johns Hopkins Textbook of Cardiothoracic Surgery
AB  - EpidemiologyAtrial  fibrillation  (AF)  affects  about  2  percent  of  the  general  population.  It  is  strongly  correlated  to  age  and  the  prevalence  increases  to  10  to  15  percent  in  patients  over  the  age  of  80.  It  is  associated  with  hypertension,  heart  failure,  valvular  heart  disease,  and  ischemic  heart  disease.  In  10  to  15  percent  there  is  no  underlying  cardiac  pathology  present  (lone  AF).PathophysiologyAF  requires  both  an  initiating  event  and  a  permissive  atrial  substrate.  While  automaticity  and  triggered  activation  is  often,  but  not  exclusively,  found  within  and  around  the  pulmonary  veins  and  is  involved  in  AF  initiation,  different  mechanisms  of  reentry  in  both  atria  also  play  an  important  role  in  sustaining  AF.  As  the  atrial  size  increases,  the  conduction  velocity  slows  or  the  atrial  refractory  period  decreases,  and  the  probability  of  initiating  and  sustaining  AF  increases.Clinical  featuresBesides  symptoms,  hemodynamic  compromise,  and  tachycardia-induced  cardiomyopathy,  stroke  remains  the  most  feared  complication.  AF  accounts  for  about  25  percent  of  strokes  in  patients  older  than  80  years  and  increases  a  person’s  risk  of  stroke  by  5-fold.DiagnosticsA  transthoracic  and  transesophageal  echocardiogram  should  determine  left  atrial  diameter  and  evaluate  for  the  presence  of  a  left  atrial  thrombus.  A  cardiac  catheterization  will  provide  information  about  the  presence  of  coronary  artery  disease  and  the  anatomical  location  of  the  circumflex  coronary  artery.  In  patients  who  have  failed  catheter  ablation,  chest  computerized  tomography  (CT)  is  indicated  to  assess  for  pulmonary  vein  stenosis.TreatmentThe  surgical  procedures  currently  performed  to  ablate  AF  include  the  biatrial  Cox-Maze  procedure  (CMP),  left  atrial  lesion  sets,  and  pulmonary  vein  isolation.  All  of  these  operations  have  been  simplified  by  alternative  energy  sources.OutcomeSuccess  rates  vary  and  depend  on  the  lesion  set  performed,  the  energy  source  used,  the  type  of  AF,  and  the  presence  of  concomitant  pathology.  The  biatrial  CMP  has  an  approximately  90  percent  success  rate  for  all  types  of  AF  and  has  set  the  benchmark  for  alternative  lesion  sets  as  well  as  for  new  and  less  invasive  approaches  currently  under  development.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/20
UR  - accesssurgery.mhmedical.com/content.aspx?aid=1104591888
ER  -