Epicardial Maze Procedure on the Beating Heart With an Infrared Coagulator

Abstract

Maze surgery is widely used to treat atrial fibrillation (AF) but requires cardiopulmonary bypass and longer aortic cross-clamping time. Percutaneous transcatheter pulmonary vein (PV) isolation is time consuming and relies on fluoroscopy and contrast media, and PV obstruction and cardiac tamponade are still major problems. To overcome these drawbacks, we developed an epicardial maze procedure with an infrared coagulator on the beating heart, and the aim of this study was to confirm electrophysiologically the efficacy of this method. Light from a lamp in the infrared coagulator is focused into a quartz rod, and the distal exit-plane of the rod is connected to a sapphire tip that allows 10 mm of linear photocoagulation. In an experiment in 5 dogs with AF, instead of making all of the incisions usually required for maze surgery, the infrared coagulator was applied epicardially to create a continuously overlapping linear lesion that was the same as the incision line in the maze III procedure except for the intraatrial incision. After the procedure, 11 electrodes were attached to both atria, and an electrophysiologic study was performed. The electrophysiologic study confirmed electrophysiologic isolation of both atrial appendages and within the PV encircling lesion. Sustained atrial fibrillation could no longer be induced. The epicardial maze procedure was successfully performed on a beating heart with the infrared coagulator.