Performing the Left Atrial Maze Ablation Pattern Without Atriotomy.

The need to perform an additional atriotomy is a major concern that keeps many surgeons from performing an extended left atrial lesion set in patients with atrial fibrillation during procedures such as aortic valve replacement. This does result either in a suboptimal lesion set or even in ignoring the rhythm disorder, leaving the patient exposed to an increased risk of stroke and possible hemodynamic compromises. This report describes a technique how pulmonary vein isolation, an isolation of the posterior left atrial wall and an anterior mitral annular line, which substitutes for the mitral isthmus line in order to prevent perimitral atrial flutter, can be performed during aortic valve replacement without the need for an atriotomy. This technique allows for an optimal time management by minimizing additional cardiopulmonary bypass-time and cross-clamp-time; however, its equivalent efficacy in successfully treating atrial fibrillation compared to the left atrial Maze IV ablation pattern needs to be revealed in future trials. (C) 2016 by The Society of Thoracic Surgeons