Surgical ablation of atrial fibrillation: the Columbia Presbyterian experience.
BACKGROUND
The Maze III procedure is an effective surgical treatment for atrial fibrillation (AF). However, it is not widely applied due to its complexity, increased operative times, and the risk of bleeding. Various energy sources have been introduced to simplify the traditional "cut and sew" approach.


METHODS
This study involves patients undergoing surgical atrial fibrillation ablation (SAFA) at a single institution from 1999 to 2005. Type of concomitant procedures, preoperative clinical characteristics, and chronicity of AF were evaluated in overall patient population. Parameters including surgical approach, lesion pattern, and energy source used were collected intraoperatively. Clinical outcomes examined were postoperative rhythm success, stroke, early mortality, and long-term survival.


RESULTS
Three hundred thirty-nine patients were identified. Three hundred twenty-eight (96.8%) patients had associated cardiac disease and underwent concomitant procedures; 75.8% of patients had persistent AF. Energy sources used were microwave (49.8%), radiofrequency (42.2%), and laser (8.0%). In 41.9% of cases a pulmonary vein encircling lesion was the only lesion created. Combination lesion sets were performed in the remaining cases. Rhythm success rates at 3, 6, 12, and 24 months were 74.1%, 68.2%, 74.5%, and 71.1%, respectively. Patients who underwent surgical removal of left atrial appendage by means of stapling or simple excision had no early postoperative stroke. Early mortality was 4.9%. Postoperative survival rates at 1, 3, and 5 years were 89.6%, 83.1%, and 78.0%.


CONCLUSIONS
Surgical ablation of atrial fibrillation is a safe and effective procedure in restoring sinus rhythm with excellent postoperative survival rates. Further advancements in the field will eventually result in minimally invasive procedures with higher success rates.
Topkara
Veli K
VK
Columbia University College of Physicians and Surgeons, New York Presbyterian Hospital, Division of Cardiothoracic Surgery, New York, NY 10032, USA. vktopkara@hotmail.com
Williams
Mathew R
MR
Cheema
Faisal H
FH
Vigilance
Deon W
DW
Garrido
Mauricio J
MJ
Russo
Mark J
MJ
Oz
Mehmet C
MC
Argenziano
Michael
M
D000368:Aged; D020517:Atrial Appendage / Q000473:pathology / Q000601:surgery; D001281:Atrial Fibrillation / Q000601:surgery*; D006348:Cardiac Surgical Procedures; D017115:Catheter Ablation / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000473:pathology / Q000601:surgery; D006801:Humans; D053208:Kaplan-Meier Estimate; D053685:Laser Therapy; D007902:Length of Stay; D008297:Male; D008872:Microwaves / Q000627:therapeutic use; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D009518:New York; D011667:Pulmonary Veins / Q000601:surgery; D012107:Research Design; D012189:Retrospective Studies; D020521:Stroke / Q000209:etiology / Q000401:mortality; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome