Epicardial Maze Procedure on the Beating Heart With an Infrared Coagulator Hiroshi Kubota, MD, Shinichi Takamoto, MD, Akira Furuse, MD, Masaya Sato, MD,

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Epicardial Maze Procedure on the Beating Heart With an Infrared Coagulator Hiroshi Kubota, MD, Shinichi Takamoto, MD, Akira Furuse, MD, Masaya Sato, MD, Hidehito Endo, MD, Tatsuo Fujiki, MD, Kenichi Sudo, MD The Annals of Thoracic Surgery Volume 80, Issue 3, Pages 1081-1086 (September 2005) DOI: 10.1016/j.athoracsur.2004.09.050 Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 (A) Infrared coagulator: the plastic body has been replaced by a metal body to enable it to tolerate the long duration of the coagulation. (B) Sapphire tip: the edge of the tip has a rectangular (1.5 × 10 mm) edge surface. The Annals of Thoracic Surgery 2005 80, 1081-1086DOI: (10.1016/j.athoracsur.2004.09.050) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 (A) Lesion pattern. Coagulation was performed along the incision line of the Maze III procedure, except intraatrial septal incision. (B) Location of the electrodes (1 to 11). After the procedure, 11 bipolar electrodes were placed in the atrial wall, and the potentials were recorded. (IVC = inferior vena cava; LAA = left atrial appendage; MV = mitral valve; RAA = right atrial appendage; SN = sinus node; SVC = superior vena cava; TV = tricuspid valve.) The Annals of Thoracic Surgery 2005 80, 1081-1086DOI: (10.1016/j.athoracsur.2004.09.050) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 (A) Atrial potential during spontaneous beating. No potential was detected within the right atrial appendage ([RAA] electrode no. 3). Other areas of the atrium exhibited sinus rhythm. No potentials were detected with the electrodes within the left atrial appendage (LAA) or pulmonary vein (PV) encircling lesion (electrodes nos. 7, 10, and 11) either. (B) During overdrive pacing from the RAA (electrode no. 3), only the area within the RAA lesion was activated by the stimulus. Other areas exhibited sinus rhythm. (C) During overdrive pacing from the LAA (electrode no. 7), only the area within the LAA lesion was activated by the stimulus. Other areas exhibited sinus rhythm. (D) During overdrive pacing from inside the PV encircling lesion, only the area within the PV encircling lesion (electrode no. 10) was activated by the stimulus. Other areas exhibited sinus rhythm. Electrode no. 11 was used to stimulate the atrium. The Annals of Thoracic Surgery 2005 80, 1081-1086DOI: (10.1016/j.athoracsur.2004.09.050) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 (A) Histologic changes in the left atrium. Well-demarcated transmurally degenerated myocardium was demonstrated. Both the endocardium and the epicardium were intact. (B) Schematic of the left atrium. The Annals of Thoracic Surgery 2005 80, 1081-1086DOI: (10.1016/j.athoracsur.2004.09.050) Copyright © 2005 The Society of Thoracic Surgeons Terms and Conditions