Late Occurrence of Atrial Arrhythmias After the Simple Left Atrial Procedure for Chronic Atrial Fibrillation in Mitral Valve Surgery Taijiro Sueda, MD,

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Late Occurrence of Atrial Arrhythmias After the Simple Left Atrial Procedure for Chronic Atrial Fibrillation in Mitral Valve Surgery Taijiro Sueda, MD, Katsuhiko Imai, MD, Kazumasa Orihashi, MD, Taiichi Takasaki, MD, Shinya Takahashi, MD, Tatsuya Kurosaki, MD The Annals of Thoracic Surgery Volume 90, Issue 6, Pages 1959-1966 (December 2010) DOI: 10.1016/j.athoracsur.2010.08.004 Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Schema of the simple left atrial procedure. A left vertical atriotomy was extended to the left margin of the left pulmonary veins (PV). After excision of the left atrial appendage (LAA), cryoablation (black areas) was delivered at −60°C for 2 minutes to the posterior wall of the left atrium. The cryoablation was directed toward the incision edges between the upper and lower left pulmonary veins, and to two areas of the posterior left atrial wall, from the upper atrial incision edge into the orifice of the left atrial appendage, and from the left lower atrial incision edge into the posterior mitral valvular annulus. The dashed lines and hatched areas represent incision and suture lines. (CS = coronary sinus; IVC = inferior vena cava; MV = mitral valve; RAA = right atrial appendage; SA = sinus node; SVC = superior vena cava; TV = tricuspid valve.) The Annals of Thoracic Surgery 2010 90, 1959-1966DOI: (10.1016/j.athoracsur.2010.08.004) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Schema of the simple left atrial procedure with tricuspid isthmus ablation. After completion of the simple left atrial procedure, cryoablation (black areas) was delivered at −60°C for 2 minutes to the tricuspid isthmus from the tricuspid annulus toward the inferior vena cava (IVC) to prevent common atrial flutter. Tricuspid annuloplasty was then performed with or without a rigid ring. The dashed lines and hatched areas represent incision and suture lines. (CS = coronary sinus; LAA = left atrial appendage; MV = mitral valve; PV = pulmonary veins; RAA = right atrial appendage; SA = sinus node; SVC = superior vena cava; TV = tricuspid valve.) The Annals of Thoracic Surgery 2010 90, 1959-1966DOI: (10.1016/j.athoracsur.2010.08.004) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Long-term freedom from atrial fibrillation (AF). The results of the long-term follow-up on patients with a successful simple left atrial procedure are shown with the actuarial proportion of patients freedom from AF (95% confidence intervals). The Annals of Thoracic Surgery 2010 90, 1959-1966DOI: (10.1016/j.athoracsur.2010.08.004) Copyright © 2010 The Society of Thoracic Surgeons Terms and Conditions