TY - JOUR
T1 - Radial approach
T2 - A new concept in surgical treatment for atrial fibrillation I. Concept, anatomic and physiologic bases and development of a procedure
AU - Nitta, Takashi
AU - Lee, Richard
AU - Schuessler, Richard B.
AU - Boineau, John P.
AU - Cox, James L.
N1 - Funding Information:
This study was supported by the National Institutes of Health (5 T32 HL007776, 5 RO1 HL32257, and 5 RO1 HL33722).
PY - 1999/1
Y1 - 1999/1
N2 - Background. The maze procedure cures atrial fibrillation; however, it isolates the pulmonary vein area and results in discordant activation in certain adjacent left atrial segments, which affects left atrial function. To preserve a more physiologic atrial transport function, we developed a new concept of surgical treatment for atrial fibrillation - the radial approach. The atrial incisions radiate from the sinus node toward the atrioventricular annular margins to allow a more physiologic atrial activation sequence and parallel the atrial coronary arteries to preserve blood supply to most atrial segments. Methods. We examined the atrial coronary arteries and the activation sequence during sinus rhythm in normal canine hearts to design the atrial incisions according to the concept of a radial approach. Results. The pattern of coronary artery distribution was centripetal, branching from the right coronary or left circumflex coronary artery at the right or left atrioventricular groove and spreading toward the sinus node. The endocardial mapping of the atria disclosed some important findings in designing the atrial incisions of the radial approach: the activation sequence at the left atrial septum and at the posterior left atrium between the pulmonary vein orifices. The atrial incisions were designed according to these findings. Conclusions. The radial approach may represent a more physiologic atrial transport function.
AB - Background. The maze procedure cures atrial fibrillation; however, it isolates the pulmonary vein area and results in discordant activation in certain adjacent left atrial segments, which affects left atrial function. To preserve a more physiologic atrial transport function, we developed a new concept of surgical treatment for atrial fibrillation - the radial approach. The atrial incisions radiate from the sinus node toward the atrioventricular annular margins to allow a more physiologic atrial activation sequence and parallel the atrial coronary arteries to preserve blood supply to most atrial segments. Methods. We examined the atrial coronary arteries and the activation sequence during sinus rhythm in normal canine hearts to design the atrial incisions according to the concept of a radial approach. Results. The pattern of coronary artery distribution was centripetal, branching from the right coronary or left circumflex coronary artery at the right or left atrioventricular groove and spreading toward the sinus node. The endocardial mapping of the atria disclosed some important findings in designing the atrial incisions of the radial approach: the activation sequence at the left atrial septum and at the posterior left atrium between the pulmonary vein orifices. The atrial incisions were designed according to these findings. Conclusions. The radial approach may represent a more physiologic atrial transport function.
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U2 - 10.1016/S0003-4975(98)01364-2
DO - 10.1016/S0003-4975(98)01364-2
M3 - Article
C2 - 10086522
AN - SCOPUS:0032991752
SN - 0003-4975
VL - 67
SP - 27
EP - 35
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 1
ER -