Initial Experience of Sequential Surgical Epicardial-Catheter Endocardial Ablation for Persistent and Long-Standing Persistent Atrial Fibrillation With.

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Ablation of Atrial Fibrillation With Minimally Invasive Mitral Surgery

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Initial Experience of Sequential Surgical Epicardial-Catheter Endocardial Ablation for Persistent and Long-Standing Persistent Atrial Fibrillation With Long-Term Follow-Up Srijoy Mahapatra, MD, Damien J. LaPar, MD, Sandeep Kamath, MD, Jason Payne, MD, Kenneth C. Bilchick, MD, James M. Mangrum, MD, Gorav Ailawadi, MD The Annals of Thoracic Surgery Volume 91, Issue 6, Pages 1890-1898 (June 2011) DOI: 10.1016/j.athoracsur.2011.02.045 Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Schematic representation of epicardial (bold) and endocardial (dashed) ablation lines for Sequential procedure. The Annals of Thoracic Surgery 2011 91, 1890-1898DOI: (10.1016/j.athoracsur.2011.02.045) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Electrophysiology procedure flow chart. (AF = atrial fibrillation; CFAE = complex fractionated atrial electrogram; CS = coronary sinus; CV = cardioversion; LI-MI Line = from left inferior pulmonary vein to mitral valve; PVs = pulmonary veins; SVC = superior vena cava.) The Annals of Thoracic Surgery 2011 91, 1890-1898DOI: (10.1016/j.athoracsur.2011.02.045) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Results of Sequential electrophysiology study. Atrial fibrillation (AF)-alone was induced in 2, and 7 atrial flutters were induced in 5. (CFAE = complex fractionated atrial electrogram; CTI = cavotricuspid isthmus; CV = cardioversion; LAA = left atrial appendage; LSPV = left superior pulmonary vein; PV = pulmonary vein; SR = sinus rhythm; SVC = superior vena cava.) The Annals of Thoracic Surgery 2011 91, 1890-1898DOI: (10.1016/j.athoracsur.2011.02.045) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Location of gaps found at electrophysiology study: 4/15 gaps on roof line, and 4/15 had a presumed gap in line to mitral valve. The Annals of Thoracic Surgery 2011 91, 1890-1898DOI: (10.1016/j.athoracsur.2011.02.045) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 5 Overall freedom from recurrence of atrial arrhythmia or anti-arrhythmic drug (AAD) use for all patients undergoing Sequential versus catheter-alone ablation. The Annals of Thoracic Surgery 2011 91, 1890-1898DOI: (10.1016/j.athoracsur.2011.02.045) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions

Fig 6 Overall freedom from recurrence of atrial fibrillation for all patients undergoing Sequential versus catheter-alone ablation, while on anti-arrhythmic drug (AAD) therapy. The Annals of Thoracic Surgery 2011 91, 1890-1898DOI: (10.1016/j.athoracsur.2011.02.045) Copyright © 2011 The Society of Thoracic Surgeons Terms and Conditions