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J Thorac Cardiovasc Surg 2006;132:224-225
© 2006 The American Association for Thoracic Surgery

Editorial

Must we cross the wall to get to the other side?

Adam E. Saltman, MD, PhD *

University of Massachusetts Memorial Medical Center, Division of Cardiothoracic Surgery, Worcester, Mass.

Received for publication March 31, 2006; accepted for publication April 11, 2006.

* Address for reprints: Adam E. Saltman, MD, PhD, Director, CT Surgery Research, Co-Director, AF Center, Maimonides Medical Center, 4802 Tenth Avenue, Brooklyn, NY 11219. (Email: asaltman@maimonidesmed.org).

The first 20% of the full text of this article appears below.

GoIn this issue of the Journal, Melby and colleagues 1 Go present a preclinical study of microwave radiation used to ablate the atrium of the beating heart. It is the first article to address the important issue of ablation effectiveness when energies are applied to the epicardium of the beating, working heart with a device that lends itself to a minimal-access approach. It is an important initial contribution to our nascent knowledge base, and it is a well-performed study.

There are 2 very important overarching questions raised by this type of research. The first really concerns the future of atrial fibrillation surgery: Can ablative energy sources create truly transmural lesions when used from the epicardium on the beating, filled heart? Fortunately, this is a purely technical question; with the right animal (and perhaps human) models it can be definitively answered. The second question, however, is much more vexing: Are transmural lesions necessary to cure atrial fibrillation? We certainly have an extensive and detailed database gathered over the last 15 years concerning the Maze operation, a procedure that ensured transmurality by virtue of its cut-and-sew lesions; we know the results with that approach. As the field of atrial fibrillation surgery moves to less-destructive and less-invasive methods in a drive to treat more . . . [Full Text of this Article]


Related Article

Epicardial microwave ablation on the beating heart for atrial fibrillation: The dependency of lesion depth on cardiac output
Spencer J. Melby, Andreas Zierer, Scott P. Kaiser, Richard B. Schuessler, and Ralph J. Damiano, Jr
J. Thorac. Cardiovasc. Surg. 2006 132: 355-360. [Abstract] [Full Text] [PDF]



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S. K. Balasubramanian, T. Theologou, and I. Birdi
Microwave surgical ablation for atrial fibrillation during off-pump coronary artery surgery using total arterial-Y-grafts: an early experience
Interactive CardioVascular and Thoracic Surgery, August 1, 2007; 6(4): 447 - 450.
[Abstract] [Full Text] [PDF]


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