Geschichte der Rhythmuschirurgie mit Fokus auf die chirurgischen Ablationsverfahren zur Behandlung des Vorhofflimmerns

Abstract

Rhythm surgery, which was initiated many years ago, has fundamentally changed by the development of sparing interventional treatment procedures and the successful introduction of the implantable defibrillator.A cornerstone in the history was the first successful treatment of a patient with Wolff-Parkinson-White-Syndrome separating accessory conduction lines between atrium and ventricle in 1968. The experience and knowledge of the surgical therapy of the 70ies has promoted the implementation of successful interventional ablation procedures in the early 80ies.Further steps in the rapidly developing area of rhythm surgery were the left and right atrial isolation procedures for the treatment of automatically atrial tachycardia's, the use of cryo-surgery for AV-node ablation in patients with AV-re-entry tachycardia's in the 80ies and finally the procedures for the treatment of atrial fibrillation like the transsection procedure, the corridor operation and the Maze procedure. Special methods for the therapy of ventricular arrhythmias should be mentioned for the sake of completeness, but are not extensively discussed. These are the right ventricular disconnection procedure, endocardial and subendocardial resections, endocardial cryo-ablation, the Jatene- and Dor-operation for the treatment of ischemic ventricular arrhythmias. Out of the original indications, today the therapy of atrial fibrillation has become more and more important and represents a booming part of rhythm surgery in the last decade. The unsatisfactory results of medical treatment, new understanding of the pathophysiology of atrial fibrillation and the introduction of simplified ablation procedures have led to a markable increase of rhythm surgery procedures. One reason is the increasing life expectancy of the population leading to a higher incidence of atrial fibrillation, which makes this arrhythmia to the most common rhythm disturbance. This growing number of patients is a challenge for cardiac surgery today and leads the focus on this special part.