Invited Commentary on Role of Simultaneous Sequential Strategy for Failed Acute Sinus Restoration After Modified Left Maze Procedure for Persistent Atrial Fibrillation with Concomitant Mitral Surgery

Excerpt

In this issue, Chang et al. (DOI: 10.1007/s00268-006-0382-0) report on their experience with the operative approach of selective simultaneous sequential right atrial ablation for failed acute sinus rhythm restoration after a modified left Maze procedure.1 Their small prospective cohort consisted of 27 patients undergoing surgical ablation of atrial fibrillation (AF) concomitant with mitral valve surgery using a combination of irrigated radiofrequency ablation and cryoablation. Of the 27 patients who were operated on with this strategy, a left Maze ablation was not sufficient in 7 patients (25.9%) who then received simultaneous sequential right side ablation resulting in acute restoration of sinus rhythm in 6 patients. At a mean follow up of 17.8 months, 88.9% of the patients remained in sinus rhythm despite the fact that no anti-arrhythmic agents were administered in the perioperative period or late postoperatively. This overall sinus conversion rate is comparable to that reported with biatrial ablation. …