Page 23 - ADD-ON ABLATION SURGERY IN PATIENTS WITH ATRIAL FIBRILLATION

Nonetheless, there is no full consensus127-128 about AF ablation as first-line therapy.
Areas of concern are the variable short-term efficacy of catheter ablation, its 1 unknown long-term efficacy, significant procedure-related complications and
the significant variance of success among laboratories using similar ablation techniques139.
Surgical procedures
Add-on surgery
The add-on surgery is a procedure performed to treat AF during cardiac surgery. In this technique, a number of incisions or ablations are made.
The Cox–Maze III technique
The Cox-Maze III procedure is still the gold standard to treat AF. During the procedure, a number of incisions are made on the left and right atrium to form scar tissue, which does not conduct electricity and disrupts the path of abnormal electrical impulses. The Maze procedure requires cardiopulmonary bypass and cardiac arrest and, also in experienced hands, it requires 45–60 min of cardiopulmonary bypass and cardiac arrest130. Thus, even with these modifications, the Maze III remains a complex procedure and this may explain why many surgeons worldwide are reluctant to perform the procedure.
The Cox–Maze IV technique
On the basis of advances in the understanding of the pathophysiology of AF, a variety of new ablation tools have been developed to facilitate surgical ablation of AF.These probes and catheters rely on alternative energy sources to create long, continuous, linear lesions that block conduction.
In 2002, a new iteration of the Cox-Maze procedure was introduced, termed the Cox–Maze IV procedure, which replaced most of the incisions with linear lines of bipolar radiofrequency ablation131. Conflicting results were reported after the Cox–Maze IV technique132-133.
The Group of Damiano134 had previously carried out a propensity analysis of matched patients undergoing the Cox–Maze III versus Cox–Maze IV procedures which showed that there was no significant difference between these two procedures in terms of the rates of freedom from AF at 3, 6 and 12 months with
Introduction
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