title: Totally thoracoscopic left atrial Maze: standardized, effective and safe.
abstract: OBJECTIVE
  The totally thoracoscopic left atrial Maze (TT-Maze) is a relatively new surgical solution for the treatment of atrial fibrillation (AF). The procedure consists of a complete left atrial Maze, which is performed by video-assisted thoracoscopy with the use of radiofrequency ablation. We describe our rhythm results as well as our learning curve experience of the TT-Maze.
  
  
  METHODS
  To evaluate the learning curve, all consecutive patients who underwent a TT-Maze and were operated by one surgeon (Bart P. Van Putte) were included in the study. The endpoint of surgery was sinus rhythm with a bidirectional block of the box and pulmonary veins.
  
  
  RESULTS
  A total of 83 patients were included. Fifty percent of the patients had paroxysmal AF. The mean indexed left atrial volume was 44 ± 15 ml/m(2) and 38% of the patients had a previous catheter ablation for AF. During a mean follow-up of 10.9 ± 4.9 months, there were no major events. At latest follow-up, 82% of the patients did not have a single registration of AF or other atrial tachyarrhythmias longer than 30 s. Patients without AF were also free from anti-arrhythmic drugs in 90% of the cases, free from coumadins or direct oral anticoagulants in 63% of the cases and free from both in 58% of the cases.
  
  
  CONCLUSIONS
  After almost 1-year follow-up, the TT-Maze is proved to be a successful, safe and reproducible strategy for the treatment of all types of AF including patients with enlarged left atria and previously failed catheter ablation.
authors.affiliation: Department of Cardio-Thoracic Surgery, St Antonius Hospital, Nieuwegein, Netherlands g.s.c.geuzebroek@gmail.com.
authors.forename: Guillaume S C
authors.initials: GS
authors.lastname: Geuzebroek
authors.affiliation: Department of Cardio-Thoracic Surgery, Amphia Hospital, Breda, Netherlands.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Bentala
authors.affiliation: Department of Cardiology, Amphia Hospital, Breda, Netherlands.
authors.forename: Sander G
authors.initials: SG
authors.lastname: Molhoek
authors.affiliation: Department of Cardio-Thoracic Surgery, St Antonius Hospital, Nieuwegein, Netherlands.
authors.forename: Johannes C
authors.initials: JC
authors.lastname: Kelder
authors.affiliation: Department of Cardiology, Amphia Hospital, Breda, Netherlands.
authors.forename: Jeroen
authors.initials: J
authors.lastname: Schaap
authors.affiliation: Department of Cardio-Thoracic Surgery, St Antonius Hospital, Nieuwegein, Netherlands Department of Cardio-Thoracic Surgery, Amphia Hospital, Breda, Netherlands.
authors.forename: Bart P
authors.initials: BP
authors.lastname: Van Putte
mesh_terms: D000368:Aged; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D002983:Clinical Competence; D005260:Female; D006801:Humans; D059032:Learning Curve; D008297:Male; D008875:Middle Aged; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: Atrial fibrillation; Maze; Mini-Maze; Pulmonary vein isolation; Thoracoscopic ablation; Totally thoracoscopic Maze