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Surgical therapy of paroxysmal atrial fibrillation with the "corridor" operation
J J Defauw1, G M Guiraudon, N M van Hemel
1Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, The Netherlands.
Insights
The corridor operation, a novel surgical approach for paroxysmal atrial fibrillation, successfully treated 16 of 20 patients by isolating a small atrial region. Refinements are needed, but the concept is sound for drug-refractory cases.
Area of Science:
- Cardiac Surgery
- Electrophysiology
- Atrial Fibrillation Management
Background:
- Paroxysmal atrial fibrillation (PAF) can severely disable patients unresponsive to medical therapy.
- Understanding AF mechanisms led to the "corridor" surgical concept.
Purpose of the Study:
- To evaluate the efficacy and safety of the corridor operation for drug-refractory PAF.
- To assess the long-term success and quality of life improvements in treated patients.
Main Methods:
- A cohort of 20 patients with disabling PAF underwent the corridor operation between 1987 and 1990.
- The procedure aimed to create an isolated "corridor" within the atria to prevent AF.
- Reoperations were performed in select cases to address persistent conduction issues.
Main Results:
- Permanent success was achieved in 16 out of 20 patients (80%).
- No ventricular AF was observed or inducible in successfully treated patients.
- Sinus node function remained intact, and quality of life improved significantly in cured patients.
Conclusions:
- The corridor operation concept is effective for treating drug-refractory PAF.
- Surgical technique refinement is necessary to ensure persistent atrial isolation.
- The procedure offers a viable treatment option for severely symptomatic PAF patients.
Abstract:
Patients with paroxysmal atrial fibrillation may be extremely disabled despite medical therapy. Based on recent concepts of atrial fibrillation, a surgical open heart procedure was designed to isolate a "corridor" from the right and the left atrium. The corridor consists of the sinus node area, the atrioventricular nodal junction, and the connecting right atrial mass, small enough to prevent atrial fibrillation. Between 1987 and 1990, 20 patients with severely disabling symptoms due to frequent paroxysmal atrial fibrillation underwent the corridor operation, with permanent success in 16 patients. In 8 patients, left atrium to corridor conduction reappeared shortly after the procedure. Reoperation was performed in these patients without extracorporeal circulation. The site of persistent conduction between the left atrium and the corridor could consistently be localized adjacent to the coronary sinus. Nevertheless, reoperation failed to isolate permanently the corridor in 4 patients. During a mean follow-up of 20 months, atrial fibrillation dominating the ventricles was never observed nor inducible in the corridor in the 16 patients with a successful operation. In all cured patients, sinus node function remained undisturbed. Paroxysmal atrial flutter inside the corridor arose in 1 patient and a paroxysmal focal tachycardia in another. All 16 cured patients experienced a clear improvement in quality of life. Refinement of the surgical technique to obtain persistent isolation between the left atrium and the corridor is needed. These results demonstrate that the concept of the corridor operation is sound and justify its use in the treatment of drug-refractory paroxysmal atrial fibrillation.