title: [Combined endocardial and epicardial radiofrequency modified Maze procedure in the treatment of atrial fibrillation].
abstract: OBJECTIVE
  To evaluate the effectiveness of the combined endocardial and epicardial saline-irrigated radiofrequency modified maze procedure for the treatment of atrial fibrillation (AF).
  
  
  METHODS
  During a period of 3 years, 295 patients with AF having concomitant cardiac surgery underwent the procedure. Patients underwent either the endocardial and epicardial group (n=185) or the endocardial group (n=110) radiofrequency ablation. There were 124 males, 171 females with a mean age of (52 +/- 11) year old. Mean duration of preoperative AF was 36 +/- 43 months. And about 90.8 percent valve pathology was rheumatic. Valve operation was performed in 289 patients, coronary artery bypass graft surgery in 19 patients and congenital heart disease operation in 6 patients respectively. Follow-up for the whole patients ranged from 3 to 47 months (mean 28 +/- 5 months).
  
  
  RESULTS
  Ten patients died postoperatively (3.4%). Four patients died of low cardiac output, five patients died of multisystem and organ failure, one patient died of cerebral hernia. There were 2 patients died of nerves system complication during follow-up. At the end of the procedure 228 patients (77.3%) were sinus rhythm, including 78 patients (70.9%) in endocardial group while 150 patients (81.1%) in endocardial and epicardial group (P<0.05). At late follow-up, 191 of 259 patients (73.7%) were in stable sinus rhythm. Sinus rhythm was present in 64 patients (66.0%) in endocardial group while 127 patients (78.4%) in endocardial and epicardial group (P<0.05). Histopathology of the endocardial group revealed foci coagulative necrosis was limited to the endocardial side. While endocardial and epicardial ablation had full-thickness alteration of atrial tissue besides ill defined borders and inflammatory cell infiltration.
  
  
  CONCLUSIONS
  Combined endocardial and epicardial saline-irrigated radiofrequency modified maze procedure was performed safely and efficiently. And it restored sinus rhythm better than endocardial ablation only.
authors.affiliation: Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China. wangjiangang7545@126.com
authors.forename: Jian-gang
authors.initials: JG
authors.lastname: Wang
authors.forename: Xu
authors.initials: X
authors.lastname: Meng
authors.forename: Hui
authors.initials: H
authors.lastname: Li
authors.forename: Yong-qiang
authors.initials: YQ
authors.lastname: Cui
authors.forename: Xiao-tong
authors.initials: XT
authors.lastname: Hou
authors.forename: Feng
authors.initials: F
authors.lastname: Gao
authors.forename: Si-hong
authors.initials: SH
authors.lastname: Zheng
authors.forename: Chun-lei
authors.initials: CL
authors.lastname: Xu
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D004699:Endocardium / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010496:Pericardium / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome