The five-box thoracoscopic maze procedure.
OBJECTIVE
Comprehensive treatment of atrial fibrillation requires both compartmentalization of the posterior left atrium and connecting ablations to the mitral annulus to interrupt perimitral macro reentry and to isolate the arrhythmogenic left atrial substrate. We present a new procedure that compartmentalizes virtually all arrhythmogenic anatomy etiologic in atrial fibrillation, enabling simple verification by demonstration of bidirectional block.


METHODS
Through a totally thoracoscopic approach, complete dissection of the transverse sinus and exposure of the left atrial floor enables the creation of contiguous compartments connecting to the anterior mitral trigone and isolating the posterior left atrium. The result is a comprehensive electrophysiologic replication of the Cox Maze left atrial lesion pattern.


RESULTS
Each compartment is verified in real time using bidirectional block with a probe placed on the untreated atrium inside the compartment.


CONCLUSIONS
Interruption of perimitral macro reentry in two perpendicularly oriented planes in a totally thoracoscopic procedure results in an operation with efficacy approximating the Cox Maze benchmark.
Sirak
John
J
Division of Cardiothoracic Surgery, Ohio State University, Columbus, Ohio, USA. johnsirak@yahoo.com
Jones
Danielle
D
Schwartzman
David
D
D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013906:Thoracoscopy / Q000379:methods*