Ann Thorac Surg 2007;83:1723
© 2007 The Society of Thoracic Surgeons
Original Articles: Cardiovascular
Invited commentary
G. Hossein Almassi, MD
Division of Cardiothoracic Surgery, Medical College of Wisconsin, 9200 W Wisconsin Ave, Milwaukee, WI 53226
(Email: halmassi{at}mcw.edu).
There has been an explosion in the number of operations directed at treating atrial arrhythmias and more specifically atrial fibrillation. This has been aided by technological advances and the availability of new energy sources substituted for the "cut and sew" technique as developed by Cox in the 1980s. These new energy sources have in turn led to the development of the so-called minimally invasive approaches by some surgeons toward treating atrial fibrillation. Regardless of the surgical approach and the energy source used, the lesions set created have to be transmural to ensure success of the operation and curing the patient. After all, the high success rate of the gold standard cut and sew technique was due to its 100% transmurality of the surgical incisions.
In the current issue, Lukac and colleagues [1] have looked at the subject of pro-arrhythmogenicity of nontransmural cryolesions in the right atrium in adult patients undergoing surgical repair of congenital heart defects, predominantly atrial septal defect. In their sophisticated electrophysiological studies they noted fractionated electrograms at the site of the cryolesion in all patients who did not have bidirectional block. This is an important point and something that all surgeons involved with treatment of atrial arrhythmias need to consider when using new technology and energy sources to avoid unintended consequences of nontransmural lesions. Transmurality of the lesion and complete block across the lesion should be verified intraoperatively if we are going to match the cure rate offered by surgical incisions. Using either custom made or commercially made available devices, surgeons should try to confirm the presence of complete block across the lesions intraoperatively.
Lukac and colleagues [1] should be congratulated on a nice study.
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- Lukac P, Hjortdal VE, Pedersen AK, Mortensen PT, Jensen HK, Hansen PS, et al. Prevention of atrial flutter with cryoablation may be proarrhythmogenic Ann Thorac Surg 2007;83:1717-1723.[Abstract/Free Full Text]
Related Article
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Prevention of Atrial Flutter With Cryoablation May Be Proarrhythmogenic
- Peter Lukac, Vibeke E. Hjortdal, Anders K. Pedersen, Peter T. Mortensen, Henrik K. Jensen, and Peter S. Hansen
Ann. Thorac. Surg. 2007 83: 1717-1723.
[Abstract]
[Full Text]
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