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• W3033914516 abstract "Long-standing persistent atrial fibrillation represents the worst enemy of cardiologists and surgeons who want to “ablate” this pathology. Recently, new hybrid treatments have been introduced to reduce the invasiveness of conventional treatments and the rate of recurrence at follow-up. However, although the results obtained are always better, there is a debate on the best strategy to adopt. Within this debate we read the article by Lapenna and colleagues1Lapenna E. De Bonis M. Giambuzzi I. et al.Long-term outcomes of stand-alone maze IV for persistent or long-standing persistent atrial fibrillation.Ann Thorac Surg. 2020; 109: 124-131Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar who presented a series of cases with patients treated with the Maze IV technique, obtaining very encouraging results, even at follow-up. However, the invasiveness of treatment, which requires the use of extracorporeal circulation, in patients with stand-alone atrial fibrillation, obliges surgeons—to convince patients and cardiologists of the efficacy and safety of the treatment—to have results more than optimal. Undoubtedly, 67% of atrial fibrillation-free patients registered by the investigators at follow-up is an important result; however, a third of patients with recidivism remains, although undergoing cardiac surgery. Regardless of the pharmacologic protocol used in association, which can also play its role,2Babokin V. Trofimov N. Prevention of atrial fibrillation recurrence after the Maze IV procedure.Ann Thorac Surg. 2020; 109: 1624-1625Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar there are also anatomic considerations that we believe may affect the results. Bachmann's bundle is a muscular structure comprising parallel-aligned myocardial strands connecting the right and left atrial wall and is the main pathway of interatrial conduction.3van Campenhout M.J. Yaksh A. Kik C. et al.Bachmann's bundle: a key player in the development of atrial fibrillation?.Circ Arrhythm Electrophysiol. 2013; 6: 1041-1046Crossref PubMed Scopus (53) Google Scholar Surgical isolation of Bachmann's bundle does not require additional blunt dissection as it is easily accessible from the epicardium; therefore, surgical ablation may be more effective than endocardial catheter-based ablation.3van Campenhout M.J. Yaksh A. Kik C. et al.Bachmann's bundle: a key player in the development of atrial fibrillation?.Circ Arrhythm Electrophysiol. 2013; 6: 1041-1046Crossref PubMed Scopus (53) Google Scholar The Maze IV technique, in its complexity and completeness, does not provide for ablation at this level.4Cox J.L. Churyla A. Malaisrie S.C. et al.A hybrid maze procedure for long-standing persistent atrial fibrillation.Ann Thorac Surg. 2019; 107: 610-618Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar In our series of patients with long-standing persistent atrial fibrillation, a two-staged hybrid ablation was performed, and freedom from atrial arrhythmia recurrence rates at follow-up was 96.6% in the patients with associated Bachmann's bundle ablation, and 76.6% in the patients without. This consideration aims to confirm the quality of the “complete” treatment for atrial fibrillation, but hypothesizes a potential greater efficacy by adding the Bachmann's bundle treatment. Long-term Outcomes of Stand-Alone Maze IV for Persistent or Long-standing Persistent Atrial FibrillationThe Annals of Thoracic SurgeryVol. 109Issue 1PreviewThe study sought to assess the long-term outcomes of the stand-alone Cox-Maze IV procedure in symptomatic patients with refractory, persistent, or long-standing persistent atrial fibrillation (AF). Full-Text PDF Bachmann Bundle and Atrial Fibrillation Ablation: ReplyThe Annals of Thoracic SurgeryVol. 110Issue 6PreviewWe would like to thank Nasso and colleagues1 for their comments about our study.2 However, it is important to emphasize that our series is focused on the long-term (7-year) outcomes of the maze IV procedure,2 which is a completely different approach compared with the hybrid treatment described by Nasso and coworkers.1 They underline that surgical ablation of the Bachmann bundle (BB) may positively affect the outcomes of atrial fibrillation (AF) surgery with an off-pump epicardial technique. However, this issue is still a matter of debate. Full-Text PDF" @default.
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• W3033914516 date "2020-12-01" @default.
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• W3033914516 title "Maze Therapy for Long-Standing Persistent Atrial Fibrillation: Can We Do Even Better?" @default.
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• W3033914516 doi "https://doi.org/10.1016/j.athoracsur.2020.04.039" @default.
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