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Review and Clinical Update

James L. Cox, MD; John P. Boineau, MD; Richard B. Schuessler, PhD; T. Bruce Ferguson, Jr, MD; Michael E. Cain, MD; Bruce D. Lindsay, MD; Peter B. Corr, PhD; Kathy M. Kater, MSN; Demetrios G. Lappas, MD

JAMA. 1991;266(14):1976-1980.

Abstract
Atrial fibrillation is the most common of all sustained cardiac arrhythmias, yet it has no effective medical or surgical therapy. During the past decade, multipoint computerized electrophysiological mapping systems were used to map both experimental and human atrial fibrillation. On the basis of these studies, a new surgical procedure was developed for atrial fibrillation. Between September 25, 1987, and July 1,1991, this procedure was applied in 22 patients with paroxysmal atrial flutter (n = 2), paroxysmal atrial fibrillation (n = 11), or chronic atrial fibrillation (n = 9) of 2 to 21 years' duration. All patients were refractory to all antiarrhythmic medications, and each patient failed to receive the desired therapeutic benefits of an average of five drugs administered preoperatively. There were no operative deaths and all perioperative morbidity resolved. All 22 patients have been successfully treated for atrial fibrillation with surgery alone. Three patients developed one late isolated episode of atrial flutter at 5, 6, and 15 months postoperatively, and each of these patient's symptoms is now controlled by a single antiarrhythmic drug. Preservation of atrial transport function has been documented in all patients postoperatively, and all have experienced marked clinical improvement.

(JAMA. 1991;266:1976-1980)

Author Affiliations
From the Division of Cardiothoracic Surgery, Department of Surgery (Drs Cox, Boineau, Schuessler, Ferguson, and Ms Kater), the Division of Cardiology, Department of Medicine (Drs Cain Lindsay, and Corr), and the Division of Cardiothoracic Anesthesiology, Department of Anesthesiology (Dr Lappas), Washington University School of Medicine and Barnes Hospital, St Louis, Mo.

Footnotes
Reprint requests to Washington University School of Medicine, One Barnes Hospital Plaza, Suite 3108, Queeny Tower, St Louis, MO 63110 (Dr Cox).

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