title: Ablation in selective patients with long-standing persistent atrial fibrillation: medium-term results of the Dallas lesion set.
abstract: OBJECTIVE
  The aim of the study was to investigate the efficacy and safety of the Dallas lesion set, which mimics the Cox-maze III left atrial (LA) lesions, for long-standing persistent atrial fibrillation (LSPAF).
  
  
  METHODS
  Over a 4-year period, 103 LSPAF patients were treated with the Dallas lesion set. Linear lesions were created at the roofline, at the anterior line and between the roofline and left atrial appendage (LAA). All patients underwent ganglionated plexi ablation and LAA excision as well as pulmonary vein isolation. Follow-up at 6, 12 and 24 months was performed by 48-h Holter recordings and real-time 3-dimensional echocardiography.
  
  
  RESULTS
  At the 24-month follow-up, 83 of 103 (80.6%) patients were free of any atrial arrhythmia lasting >30 s, with 77 patients (74.8%) off of antiarrhythmic drugs (AADs). At 3.1 ± 0.7 years, 74 of 103 patients (71.8%) were in sinus rhythm, with 71 patients (68.9%) off AADs. The optimal cut-off value of LA dimension to discriminate atrial arrhythmia recurrence was 55 mm (receiver operating characteristic curve analysis), and the Kaplan-Meier analysis showed that patients with an LA dimension of <55 mm had less recurrence during the follow-up (log-rank test, P = 0.015). After 6 months, a significant reduction in LA volume and improvement in LA function was noted in patients without recurrence (P < 0.05). In contrast, patients with recurrence showed no improvement in LA volume or function.
  
  
  CONCLUSIONS
  The Dallas lesion set is an effective treatment in patients with LSPAF. It resulted in significant improvement in LA volume and function after restoration of sinus rhythm.
authors.affiliation: Department of Atrial Fibrillation Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China wangjiangang7545@126.com.
authors.forename: Jian-Gang
authors.initials: JG
authors.lastname: Wang
authors.affiliation: Department of Atrial Fibrillation Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Meng
authors.initials: M
authors.lastname: Xin
authors.affiliation: Department of Atrial Fibrillation Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Han
authors.affiliation: Department of Atrial Fibrillation Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Atrial Fibrillation Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Tian-Ge
authors.initials: TG
authors.lastname: Luo
authors.affiliation: Department of Atrial Fibrillation Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Atrial Fibrillation Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Meng
authors.affiliation: Department of Atrial Fibrillation Center, Beijing Anzhen Hospital, Capital Medical University, Beijing, China wangjiangang7545@126.com.
authors.forename: Xu
authors.initials: X
authors.lastname: Meng
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D019560:Echocardiography, Three-Dimensional; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods*
keywords: Atrial fibrillation; Long-standing persistent atrial fibrillation; Maze procedure; Video-assisted thoracoscopic surgery