Arrhythmia surgery for atrial fibrillation associated with atrial septal defect: Right-sided maze versus biatrial maze Yu-Mi Im, MS, Joon Bum Kim, MD,

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Arrhythmia surgery for atrial fibrillation associated with atrial septal defect: Right-sided maze versus biatrial maze Yu-Mi Im, MS, Joon Bum Kim, MD, Sung-Cheol Yun, PhD, Jae Won Lee, MD, Cheol Hyun Chung, MD, Jeong-Jun Park, MD, Tae-Jin Yun, MD, PhD The Journal of Thoracic and Cardiovascular Surgery Volume 145, Issue 3, Pages 648-655.e1 (March 2013) DOI: 10.1016/j.jtcvs.2012.12.002 Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Schematic illustration of the BA. After the right atrial auricle is excised (lesion 1), an oblique incision is made on the right atrial lateral wall from the base of the resected appendage to within 3 to 4 cm of the inferior vena cava (lesion 2). The left atrial auricle is isolated (lesion 3), and the pulmonary veins are isolated to form a box (lesion 4). A connection lesion between the left atrial auricle isolation and the PVI box (lesion 5) is created, and another connection lesion between the PVI box and the mitral valve annulus (lesion 6, left atrial isthmus) is created. Lesion 7 is created from the resected margin of the right atrial auricle to the anteroseptal commissure of the tricuspid valve, and a longitudinal incision is made from the superior vena cava to the inferior vena cava parallel to the plane of the atrial septum (lesion 8). Perpendicularly from the inferior portion of lesion 8, a transverse incision is made in the lateral wall of the right atrium, heading to the anterior-posterior commissure of the tricuspid valve (lesion 9). Another lesion from the midportion of lesion 8 is made to the right-side margin of ASD (or PVI box) (lesion 10), and the last lesion (lesion 11, right atrial isthmus) is created from the inferomedial margin of the ASD to the base of the coronary sinus, and then to the posteroseptal commissure of the tricuspid valve. The Journal of Thoracic and Cardiovascular Surgery 2013 145, 648-655.e1DOI: (10.1016/j.jtcvs.2012.12.002) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Freedom from the first episode of AF recurrence, atrial flutter, atrial tachyarrhythmias, or permanent pacemaker implantation. BA, Biatrial maze procedure; RA, right atrial maze procedure. The Journal of Thoracic and Cardiovascular Surgery 2013 145, 648-655.e1DOI: (10.1016/j.jtcvs.2012.12.002) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure E1 Annual incidence of various maze procedures. RA, Right atrial maze procedure; PVI, pulmonary vein isolation; BA, biatrial maze procedure. The Journal of Thoracic and Cardiovascular Surgery 2013 145, 648-655.e1DOI: (10.1016/j.jtcvs.2012.12.002) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure E2 Freedom from AF with or without antiarrhythmic drugs at 3, 6, 12, and 24 months postoperatively. RA, Right atrial maze procedure; BA, biatrial maze procedure; AF, atrial fibrillation; PPM, permanent pacemaker; NSR, normal sinus rhythm; AAD, antiarrhythmic drugs. The Journal of Thoracic and Cardiovascular Surgery 2013 145, 648-655.e1DOI: (10.1016/j.jtcvs.2012.12.002) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions

Figure E3 Freedom from the first episode of AF recurrence, atrial flutter, atrial tachyarrhythmias, or permanent pacemaker implantation in patients with standard follow-up. RA, Right atrial maze procedure; BA, biatrial maze procedure; AF, atrial fibrillation. The Journal of Thoracic and Cardiovascular Surgery 2013 145, 648-655.e1DOI: (10.1016/j.jtcvs.2012.12.002) Copyright © 2013 The American Association for Thoracic Surgery Terms and Conditions