INTRODUCTION: The maze procedure for primary atrial fibrillation treatment, initially proposed by Cox, is somewhat complex and increases the morbidity risk originating from the isolated mitral valve surgery itself. OBJECTIVE: To describe the surgical technique, the concepts of electrophysiology considered and the initial results of a new surgical and electrophysiological approach. Also the blocking of main atrial circuits as defined by Frame and optimization of the surgical tactic for atrial fibrillation treatment are considered. METHOD: Eight patients with chronic atrial fibrillation and mitral valve dysfunction and with tricuspid valve regurgitation in one case were operated on. The following modifications of the classic Cox procedure were employed: 1. - Exclusion of the left atrium appendage by internal suturing to close its left atrial ostium; 2. - Exclusion of the right atrium appendage by one purse string suture used for the fixation of the superior vena cava draining cannula; 3. - Single atrial incision; 4. - Transendocardial electrocauterization of the left atrium wall around all the pulmonary vein ostia; 5. - Substitution of the incisions and sutures in the left atrium by transendocardial electrocauterization. RESULTS: The cardiopulmonary bypass time varied from 64 to 133 min (mean 107.5 min) and the cardioplegia time was from 40 to 105 min. (mean 76.7 min). At the end of the surgery all patients were in regular atrial rhythm. The postoperative period was uneventful with all patients discharged from hospital showing regular atrial rhythm, without definitive pacemaker implantation. Six months after surgery, six patients were in regular atrial rhythm (75%) with preserved atrial contractions, and two (25%) with atrial fibrillation, clinically controlled (NYHA II). There was no evidence of embolic complications or thrombosis seen by Doppler echocardiography. CONCLUSION: It is concluded that in this initial series of cases, the electrophysiolgical approach and the surgical technique employed improved the surgical treatment of atrial fibrillation enabling the correction of mitral and tricuspid valve lesions without additional morbidity.
Atrial fibrillation; Atrial fibrillation; Arrhythmia; Heart valve diseases; Cardiac surgical procedures; Electrophysiology
