title: Surgical aspects of atrial arrhythmia : Right atrial ablation and anti-arrhythmic surgery in congenital heart disease.
abstract: BACKGROUND
  Atrial arrhythmias are frequently described in congenital heart disease.
  
  
  OBJECTIVE
  To provide a surgical perspective of anti-arrhythmic procedures and strategic approaches.
  
  
  METHODS
  Discussion of the history of anti-arrhythmic treatments in congenital heart disease.
  
  
  RESULTS
  Before the advent of the Maze procedure (first published in 1991), surgery mainly focused on patients with Wolff-Parkinson-White syndrome and also on arrhythmias in Ebstein's malformation. Atrial septal defects (ASD) subsequently received more attention, i.e., in terms of atrial arrhythmia in the natural prognosis and the surgically modified course and in terms of surgical versus transcatheter approaches. Based on the background of various atrial arrhythmia mechanisms of ASD, several surgical procedures have been reported, ranging from the bilateral full Maze procedure to simple modification of right atriotomy. The so-called right atrial Maze procedure occupies a special position from the viewpoint of cardiology in acquired heart disease, especially in cases of frequently occurring right heart failure. In hearts with more complex structural abnormalities, a detailed understanding of the conditions to improve overall surgical outcome and develop future "anti-arrhythmic" strategies is necessary.
  
  
  CONCLUSIONS
  It is important to precisely specify factors in the individual cases, not only morphological diversity but also technical and strategic variations and their consequences. A variety of anti-arrhythmic surgical procedures are currently available. How and when to use which procedure requires professional insight and cautious clinical decision-making.
authors.affiliation: Consultant Cardiac Surgeon, Royal Brompton Hospital, Sydney Street, SW3 6NP, London, UK. humed@me.com.
authors.forename: Hideki
authors.initials: H
authors.lastname: Uemura
mesh_terms: D000328:Adult; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery*; D019317:Evidence-Based Medicine; D005260:Female; D006325:Heart Atria / Q000601:surgery; D006329:Heart Conduction System / Q000002:abnormalities* / Q000601:surgery*; D006330:Heart Defects, Congenital / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D006801:Humans; D008297:Male; D016896:Treatment Outcome
keywords: Atrial arrhythmia; Atrial septal defect; Ebstein’s malformation; Maze procedure; Surgical ablation