Prophylactic Atrial Arrhythmia Surgical Procedures With Congenital Heart Operations: Review and Recommendations Constantine Mavroudis, MD, John M. Stulak,

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Prophylactic Atrial Arrhythmia Surgical Procedures With Congenital Heart Operations: Review and Recommendations Constantine Mavroudis, MD, John M. Stulak, MD, Niv Ad, MD, Allison Siegel, MSSA, Alessandro Giamberti, MD, Louise Harris, MD, Carl L. Backer, MD, Sabrina Tsao, MD, Joseph A. Dearani, MD, Nihal Weerasena, MD, Barbara J. Deal, MD The Annals of Thoracic Surgery Volume 99, Issue 1, Pages 352-359 (January 2015) DOI: 10.1016/j.athoracsur.2014.07.026 Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 Right atrial view of potential prophylactic cavotricuspid isthmus ablative lesion set after aortobicaval cardiopulmonary bypass and cardioplegic arrest. One continuous cryoablation lesion is shown connecting tricuspid annulus at commissure of septal and posterior leaflets with inferior coronary sinus os and extending to posterior os of inferior vena cava (IVC). Additional lesion is placed to extend with cryoablation medial atriotomy to anterior os of IVC. Special care must be taken to place tricuspid-to-coronary sinus lesion away from conduction system that generally lies within triangle of Koch. This part of lesion set can be omitted if there is any question that conduction system may extend to tricuspid annulus at commissure of septal and posterior leaflets. (Ao = aorta; PA = pulmonary artery; SVC = superior vena cava.) The Annals of Thoracic Surgery 2015 99, 352-359DOI: (10.1016/j.athoracsur.2014.07.026) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Right and left atrial views of potential prophylactic ablative lesions after aortobicaval cardiopulmonary bypass and cardioplegic arrest. Shown in left atrium are lesions sets that indicate circumferential isolation of pulmonary vein confluence, connection of pulmonary vein confluence with P3 location of posterior mitral valve annulus, and connection of pulmonary vein confluence with base of left atrial appendage (LAA). (Ao = aorta; PA = pulmonary artery; SVC = superior vena cava.) The Annals of Thoracic Surgery 2015 99, 352-359DOI: (10.1016/j.athoracsur.2014.07.026) Copyright © 2015 The Society of Thoracic Surgeons Terms and Conditions