The development of simple, safe and curative strategies for the treatment of atrial fibrillation will remain one of the major challenges for invasive electophysiologists during the upcoming years. Our growing pathophysiological understanding of the arrhythmia itself has developed from surgical therapeutic strategies like the MAZE procedure and from intraoperative mapping-studies. Despite being highly effective the MAZE concept has never been practised widely due to the complexicity and the duration of the operation. During the late 1990s there was growing evidence that left atrial anchor-reentry circuits play a predominant role in precipitating atrial fibrillation. Based on the assumption that the pulmonary vein area might provide the anatomical substrate for maintainance of these anchor-reentry circuits, new surgical therapies for the curative treatment of atrial fibrillation were developed. Thus, the IRAAF concept (Intraoperative Radiofrequency Ablation of Atrial Fibrillation) covered the largest patient cohort. With the intraoperative placement of continuous left atrial lesions using radiofrequency energy, a new and highly effective therapy was established. By using a minimally invasive approach, the operation also became feasible and acceptable for the treatment of patients with lone atrial fibrillation. In this cohort the success rate in restoring sinus rhythm reached well above 95%. Because of rare but nevertheless severe complications (mainly esophageal lesions), the application of radiofrequency energy intraoperatively had to be stopped. New energy sources (e.g., cryoenergy) are currently being studied experimentally and clinically in order to enable the future use of this highly effective therapy concept for the purpose of the primary indication in atrial fibrillation again.
|Translated title of the contribution||Surgical strategies for the curative therapy of atrial fibrillation: Also for lone AF?|
|Number of pages||9|
|Journal||Herzschrittmachertherapie und Elektrophysiologie|
|Publication status||Published - Dec 2002|
- Atrial fibrillation
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine