Lesion Set Options

Lesion Set Options


Radiofrequency and cryoablation are the two ablative technologies used to perform surgical ablation. The lesion sets provided below are used by surgeons during surgical ablation, each with variant success rates.

Pulmonary Vein Isolation

PVI Alone: ~60% AFib Free1,2 (nPAF)


Pulmonary Vein Isolation for Surgical Ablation

The success of various procedures may be influenced by several factors which may predict the outcome. Duration of pre procedural Afib, type of Afib, lesion set performed, left atrial size, patient’s age, atrial fibrillation wave <1.0mm, experience of the operator, left atrial reduction, and device used.

Box Lesion Set

PVI + BOX: ~55-70% AFib Free3, 7 (nPAF)


Box Lesion Set for Surgical Ablation

The success of various procedures may be influenced by several factors which may predict the outcome. Duration of pre procedural Afib, type of Afib, lesion set performed, left atrial size, patient’s age, atrial fibrillation wave <1.0mm, experience of the operator, left atrial reduction, and device used.

Left Atrial Lesion Set

LAL: ~73-86% AFib Free4, 8 (nPAF) ~20% fewer Atrial Flutter9


Left Atrial Lesion Set for Surgical Ablation

The success of various procedures may be influenced by several factors which may predict the outcome. Duration of pre procedural Afib, type of Afib, lesion set performed, left atrial size, patient’s age, atrial fibrillation wave <1.0mm, experience of the operator, left atrial reduction, and device used.

Bi-Atrial Lesion Set
(Cox-Maze IV)

COX-MAZE IV: ~80-90% AFib Free5,6,10,11 (nPAF)

Bi-Atrial Lesion Set (Cox-Maze IV)

COX-MAZE IV: ~80-90% AFib Free5,6,10,11 (nPAF)


Left Atrial Lesion Set for Surgical Ablation

The success of various procedures may be influenced by several factors which may predict the outcome. Duration of pre procedural Afib, type of Afib, lesion set performed, left atrial size, patient’s age, atrial fibrillation wave <1.0mm, experience of the operator, left atrial reduction, and device used.

References


  1. Gillinov, A. M., Gelijns, A. C., Parides, M. K., DeRose Jr, J. J., Moskowitz, A. J., Voisine, P., … & Acker, M. A. (2015). Surgical ablation of atrial fibrillation during mitral-valve surgery. New England Journal of Medicine, 372(15), 1399-1409.

  2. Badhwar, V., Rankin, J. S., Damiano, R. J., Gillinov, A. M., Bakaeen, F. G., Edgerton, J. R., … & Thourani, V. H. (2017). The Society of Thoracic Surgeons 2017 clinical practice guidelines for the surgical treatment of atrial fibrillation. The Annals of thoracic surgery, 103(1), 329-341.

  3. Voeller, R. K., Bailey, M. S., Zierer, A., Lall, S. C., Sakamoto, S. I., Aubuchon, K., … & Moon, M. R. (2008). Isolating the entire posterior left atrium improves surgical outcomes after the Cox maze procedure. The Journal of thoracic and cardiovascular surgery, 135(4), 870-877.

  4. Barnett, S. D., & Ad, N. (2006). Surgical ablation as treatment for the elimination of atrial fibrillation: a meta-analysis. The Journal of thoracic and cardiovascular surgery, 131(5), 1029-1035.

  5. Gaynor, S. L., Schuessler, R. B., Bailey, M. S., Ishii, Y., Boineau, J. P., Gleva, M. J., … & Damiano, R. J. (2005). Surgical treatment of atrial fibrillation: predictors of late recurrence. The Journal of thoracic and cardiovascular surgery, 129(1), 104-111.

  6. Weimar, T., Bailey, M. S., Watanabe, Y., Marin, D., Maniar, H. S., Schuessler, R. B., & Damiano, R. J. (2011). The Cox-maze IV procedure for lone atrial fibrillation: a single center experience in 100 consecutive patients. Journal of interventional cardiac electrophysiology, 31(1), 47-54.

  7. Gillinov, A. M., Bhavani, S., Blackstone, E. H., Rajeswaran, J., Svensson, L. G., Navia, J. L., … & McCarthy, P. M. (2006). Surgery for permanent atrial fibrillation: impact of patient factors and lesion set. The Annals of thoracic surgery, 82(2), 502-514.

  8. Ad, N., Holmes, S. D., Lamont, D., & Shuman, D. J. (2017). Left-Sided Surgical Ablation for Patients With Atrial Fibrillation Who Are Undergoing Concomitant Cardiac Surgical Procedures. The Annals of thoracic surgery, 103(1), 58-65.

  9. Cox JL, Ad N. The importance of cryoablation of the coronary sinus during the Maze procedure. Semin Thorac Cardiovasc Surg 2000;12:20-4.

  10. Philpott, J. M., Zemlin, C. W., Cox, J. L., Stirling, M., Mack, M., Hooker, R. L., … & McCarthy, P. M. (2015). The ABLATE trial: safety and efficacy of Cox maze-IV using a bipolar radiofrequency ablation system. The Annals of thoracic surgery, 100(5), 1541-1548.

  11. Schill, M. R., Musharbash, F. N., Hansalia, V., Greenberg, J. W., Melby, S. J., Maniar, H. S., … & Damiano, R. J. (2017). Late results of the Cox-maze IV procedure in patients undergoing coronary artery bypass grafting. The Journal of thoracic and cardiovascular surgery, 153(5), 1087-1094.

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Page last updated: June 10, 2019