Anesthetic Management of Total Thoracoscopic Left Atrial Maze Procedure for Chronic Atrial Fibrillation-A Single-Institution Experience.

ATRIAL FIBRILLATION (AF) is an increasingly common health problem with a prevalence of 1% to 2% that is expected to double within 20 years. 1 Schnabel R.B. Yin X. Gona P. et al. 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: A cohort study. Lancet. 2015; 386: 154-162 Abstract Full Text Full Text PDF PubMed Scopus (839) Google Scholar , 2 Chugh S.S. Havmoeller R. Narayanan K. et al. Worldwide epidemiology of atrial fibrillation: A global burden of disease 2010 study. Circulation. 2014; 129: 837-847 Crossref PubMed Scopus (2863) Google Scholar As an independent risk factor for death and stroke, patients with AF have a 5-fold higher risk for those adverse outcomes compared to the general population. 3 Benjamin E.J. Wolf P.A. D'Agostino R.B. et al. Impact of atrial fibrillation on the risk of death: The Framingham Heart Study. Circulation. 1998; 98: 946-952 Crossref PubMed Scopus (3806) Google Scholar The goal of treatment is to interrupt the re-entrant circuits causing AF. Pharmacologic cardioversion is successful in only 35% to 75% of cases, 4 Lafuente-Lafuente C. Valembois L. Bergmann J.F. et al. Antiarrhythmics for maintaining sinus rhythm after cardioversion of atrial fibrillation. Cochrane Database Syst Rev. 2015; CD005049 PubMed Google Scholar leaving many to rely on transcatheter radiofrequency (RF) ablation or surgical treatment. The maze III operation confers a 90% freedom from AF after 5 years and long has been the gold-standard surgical treatment 5 Wolf P.A. Abbott R.D. Kannel W.B. Atrial fibrillation as an independent risk factor for stroke: The Framingham Study. Stroke. 1991; 22: 983-988 Crossref PubMed Scopus (5741) Google Scholar , 6 Ballaux P.K. Geuzebroek G.S. van Hemel N.M. et al. Freedom from atrial arrhythmias after classic maze III surgery: A 10-year experience. J Thorac Cardiovasc Surg. 2006; 132: 1433-1440 Abstract Full Text Full Text PDF PubMed Scopus (43) Google Scholar ; however, this invasive procedure requires cardiopulmonary bypass, which itself is associated with complications. The total thoracoscopic left atrial maze (ToTAM) procedure, a newer minimally invasive alternative strategy for the treatment of AF, consists of bilateral epicardial pulmonary vein isolation with the creation of a “box” lesion using RF ablation and exclusion of the left atrial appendage (LAA). 7 Yilmaz A. Van Putte B.P. Van Boven W.J. Completely thoracoscopic bilateral pulmonary vein isolation and left atrial appendage exclusion for atrial fibrillation. J Thorac Cardiovasc Surg. 2008; 136: 521-522 Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar The use of ToTAM is growing steadily, with a more than 80% success rate and limited complication rate. 8 Sirak J. Jones D. Sun B. et al. Toward a definitive, totally thoracoscopic procedure for atrial fibrillation. Ann Thorac Surg. 2008; 86: 1960-1964 Abstract Full Text Full Text PDF PubMed Scopus (32) Google Scholar , 9 De Maat G.E. Pozzoli A. Scholten M.F. et al. Surgical minimally invasive pulmonary vein isolation for lone atrial fibrillation: Midterm results of a multicenter study. Innovations (Phila). 2013; 8: 410-415 Crossref PubMed Scopus (12) Google Scholar The authors present their institutional experience with this procedure. Atrial Fibrillation: Rate, Rhythm, and BurnJournal of Cardiothoracic and Vascular AnesthesiaVol. 33Issue 7PreviewIN THIS EDITION of the journal, Sun et al.1 present their experience of providing anesthesia for thoracoscopic left atrial maze procedure for the treatment of chronic atrial fibrillation. The authors should be congratulated for openly presenting their results because it invariably opens one up to criticism, but also may provide a template for others whose institutions are embarking on these procedures. Full-Text PDF