Résultats

Chez les patients en FA non valvulaire et présentant un risque accru d’accident vasculaire cérébral ou de saignement, candidats à une anticoagulation chronique, la fermeture de l’auricule gauche a démontré une amélioration des taux d’accident vasculaire cérébral hémorragique, de décès cardiovasculaire/inexpliqué et de saignements, comparativement à la warfarine, après un suivi clinique moyen de 2,7 ans [117]. Toutefois, l’indication retenue d’occlusion de l’AG dans les recommandations européennes (patients à haut risque thromboembolique avec contre indication à une anticoagulation orale à long terme) ne correspond pas à l’indication des études randomisées publiées sur l’efficacité de l’occlusion de l’AG, mais elle reste être la première indication en pratique clinique. Ainsi, l’analyse des indications dans le registre AMULET montre que78,9 % des procédures sont liés à un risque hémorragique élevé,8,9 % à une hémorragie sous anticoagulant et 11,3 % à la survenue d’un AVC malgré un traitement anticoagulant bien conduit [118].Le point commun entre les études cliniques et les données issues de registre reste la réduction du risque ischémique et hémorragique, de l’ordre de 50 % sur la base du risque calculé par les scoresCHA2DS2VASC et HAS-BLED.

CONCLUSION

L’essor de la cardiologie/rythmologie interventionnelle offre désormais un large panel de techniques pour réduire les symptômes et les conséquences cardiaques de la fibrillation atriale. Ces procédures interventionnelles, assez largement diffusées en France, ont fait la preuve de leur efficacité (y compris médico-économique) et de leur sécurité dans de grandes études observationnelles ou randomisées. Il reste néanmoins important de bien respecter les recommandations de nos sociétés savantes afin de proposer ces procédures, non dénuées de complications, à des patients soigneusement sélectionnés, chez qui le rapport bénéfice/risque est favorable. Le futur de la prise en charge interventionnelle de la FA fera appel à une personnalisation encore plus poussée des indications et des techniques, grâce notamment à l’apport de l’imagerie et des biomarqueurs avant l’intervention.

Résumés

Résumé :

En 2030, l’Union Européenne comptera 14 à 17 millions de patients en fibrillation atriale (FA), avec 120 000 à 215 000 nouveaux cas chaque année. L’augmentation de la prévalence de cette arythmie a conduit au développement de nouvelles stratégies thérapeutiques interventionnelles, permettant de prendre en charge les différents aspects de cette maladie. Ainsi, l’ablation endocavitaire ou épicardique de la FA, par radiofréquence ou cryoablation, permet d’obtenir des résultats supérieurs à un traitement anti-arythmique dans le contrôle des symptômes et l’apparition d’insuffisance cardiaque en cas de FA paroxystique ou persistante. Chez les patients avec une maladie avancée, l’ablation de la jonction atrio-ventriculaire associée à l’implantation d’un stimulateur cardiaque bi-ventriculaire vient de démontrer sa nette supériorité, remettant au gout du jour cette technique. Enfin, en cas de risque hémorragique majeur et de contre-indication aux anticoagulants, l’occlusion de l’auricule gauche par voie percutanée aprouvé son intérêt dans la prévention des accidents emboliques liés à la FA. Le futur verra certainement l’apparition de nouvelles technologies, mais aussi de stratégies personnalisées basées sur une sélection optimale des bons candidats à ces interventions, notamment grâce à l’apport de l’imagerie en amont du geste.

ABSTRACT

In 2030, the European Union will include 14 to 17 million atrial fibrillation (AF) patients, with 120,000 to215,000 new cases each year. The increase in the prevalence of this arrhythmia has led to the development of new therapeutic intervention strategies to manage the different aspects of this disease. Thus, endocavitary or epicardial ablation of AF, by radiofrequency or cryoablation, provides superior results to antiarrhythmic therapy in controlling symptoms and preventing heart failure in paroxysmal or persistent AF. In heart failure patients with advanced AF, the ablation of the atrioventricular junction associated with the implantation of a bi-ventricular pacemaker has just demonstrated its clear superiority, bringing this technique up to date. Finally, in the event of a major bleeding risk and contraindication to anticoagulants, percutaneous occlusion of the left atrium has proven its value in preventing AF-related embolic events. The future will certainly see the emergence of new technologies but also personalized strategies based on an optimal selection of the right candidates for these interventions, thanks in particular to the contribution of imaging before the procedure.

Références

1. Camm AJ, Kirchhof P, Lip GY, Schotten U, Savelieva I, Ernst S, Van Gelder IC, Al- Attar N, Hindricks G, Prendergast B, Heidbuchel H, Alfieri O, Angelini A, Atar D, Colonna P, De Caterina R, De Sutter J, Goette A, Gorenek B, Heldal M, Hohloser SH, Kolh P, Le Heuzey JY, Ponikowski P, Rutten FH, Vahanian A, Auricchio A, Bax J, Ceconi C, Dean V, Filippatos G, Funck-Brentano C, Hobbs R, Kearney P, McDonagh T, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Vardas PE, Widimsky P, Agladze V, Aliot E, Balabanski T, Blomstrom-Lundqvist C, Capucci A, Crijns H, Dahlof B, Folliguet T, Glikson M, Goethals M, Gulba DC, Ho SY, Klautz RJ, Kose S, McMurray J, Perrone Filardi P, Raatikainen P, Salvador MJ, Schalij MJ, Shpektor A, Sousa J, Stepinska J, Uuetoa H, Zamorano JL, Zupan I. Guidelines for the

management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC).

Europace.2010;12(10):1360-1420.

2. Go AS, Hylek EM, Phillips KA, Chang Y, Henault LE, Selby JV, Singer DE. Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: The AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study. JAMA. 2001;285(18):2370-2375.

3. Savelieva I, Camm J. Update on atrial fibrillation: part I. Clin Cardiol. 2008;31(2):55- 62.

4. Benjamin EJ, Wolf PA, D'Agostino RB, Silbershatz H, Kannel WB, Levy D. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation. 1998;98(10):946-952.

5. Haissaguerre M, Jais P, Shah DC, Takahashi A, Hocini M, Quiniou G, Garrigue S, Le Mouroux A, Le Metayer P, Clementy J. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med. 1998;339(10):659-666.

6. Cappato R, Calkins H, Chen SA, Davies W, Iesaka Y, Kalman J, Kim YH, Klein G, Natale A, Packer D, Skanes A, Ambrogi F, Biganzoli E. Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation. Circ Arrhythm Electrophysiol.2010;3(1):32-38.

7. Garrey WE. Auricular fibrillation. Physiol Rev. 1924(4):215-250.

8. Schotten U, Verheule S, Kirchhof P, Goette A. Pathophysiological mechanisms of atrial fibrillation: a translational appraisal. Physiol Rev.2010; 91(1):265-325.

9. Nishida K, Michael G, Dobrev D, Nattel S. Animal models for atrial fibrillation: clinical insights and scientific opportunities. Europace.2010; 12(2):160-172.

10. Morillo CA, Klein GJ, Jones DL, Guiraudon CM. Chronic rapid atrial pacing. Structural, functional, and electrophysiological characteristics of a new model of sustained atrial fibrillation. Circulation. 1995;91(5):1588-1595.

12. Hove-Madsen L, Llach A, Bayes-Genis A, Roura S, Rodriguez Font E, Aris A, Cinca J. Atrial fibrillation is associated with increased spontaneous calcium release from the sarcoplasmic reticulum in human atrial myocytes. Circulation. 2004;110(11):1358- 1363.

12. Ming Z, Nordin C, Aronson RS. Role of L-type calcium channel window current in generating current-induced early afterdepolarizations. J Cardiovasc Electrophysiol. 1994;5(4):323-334.

13. Burashnikov A, Antzelevitch C. Reinduction of atrial fibrillation immediately after termination of the arrhythmia is mediated by late phase 3 early afterdepolarizationinduced triggered activity. Circulation. 2003;107(18):2355-2360.

14. Lewis T. Oliver-Sharpey Lectures ON THE NATURE OF FLUTTER AND FIBRILLATION OF THE AURICLE. Br Med J. 1921;1(3147):590-593.

15. Moe GK, Rheinboldt WC, Abildskov JA. A Computer Model of Atrial Fibrillation. Am Heart J. 1964;67:200-220.

16. Allessie MA, Lammers WJEP, Bonke FIM, Hollen J. Experimental evaluation of Moe's multiple wavelet hypothesis of atrial fibrillation. In: Zipes DP, Jalife, J, eds. Cardiac Electrophysiology and Arrhythmias. Orlando: Grune & Straton; 1985;p265- 275.

17. Fragakis N, Pantos I, Younis J, Hadjipavlou M, Katritsis DG. Surgical ablation for atrial fibrillation. Europace. 2012;14(11):1545-1552.

18. Allessie MA, Bonke FI, Schopman FJ. Circus movement in rabbit atrial muscle as a mechanism of trachycardia. Circ Res. 1973;33(1):54-62.

19. Jalife J, Berenfeld O, Skanes A, Mandapati R. Mechanisms of atrial fibrillation: mother rotors or multiple daughter wavelets, or both? J Cardiovasc Electrophysiol. 1998;9(8 Suppl):S2-12.

20. Jalife J, Gray R. Drifting vortices of electrical waves underlie ventricular fibrillation in the rabbit heart. Acta Physiol Scand. 1996;157(2):123-131. 314

21. Hassink RJ, Aretz HT, Ruskin J, Keane D. Morphology of atrial myocardium in human pulmonary veins: a postmortem analysis in patients with and without atrial fibrillation. J Am Coll Cardiol. 2003;42(6):1108-1114.

22. Ehrlich JR, Cha TJ, Zhang L, Chartier D, Melnyk P, Hohnloser SH, Nattel S. Cellular electrophysiology of canine pulmonary vein cardiomyocytes: action potential and

ionic current properties. J Physiol. 2003;551(Pt 3):801-813.

23. Dupont E, Ko Y, Rothery S, Coppen SR, Baghai M, Haw M, Severs NJ. The gapjunctional protein connexin40 is elevated in patients susceptible to postoperative atrial

24. de Bakker JM, Ho SY, Hocini M. Basic and clinical electrophysiology of pulmonary vein ectopy. Cardiovasc Res. 2002;54(2):287-294.

25. Po SS, Li Y, Tang D, Liu H, Geng N, Jackman WM, Scherlag B, Lazzara R, Patterson E. Rapid and stable re-entry within the pulmonary vein as a mechanism initiating

paroxysmal atrial fibrillation. J Am Coll Cardiol. 2005;45(11):1871-1877.

26. Lin WS, Tai CT, Hsieh MH, Tsai CF, Lin YK, Tsao HM, Huang JL, Yu WC, Yang SP, Ding YA, Chang MS, Chen SA. Catheter ablation of paroxysmal atrial fibrillation initiated by non-pulmonary vein ectopy. Circulation. 2003;107(25):3176-3183.

27. Calkins H, Kuck KH, Cappato R, Brugada J, Camm AJ, Chen SA, Crijns HJ, Damiano RJ, Jr., Davies DW, Dimarco J, Edgerton J, Ellenbogen K, Ezekowitz MD, Haines DE, Haissaguerre M, Hindricks G, Iesaka Y, Jackman W, Jalife J, Jais P, Kalman J, Keane D, Kim YH, Kirchhof P, Klein G, Kottkamp H, Kumagai K, Lindsay BD, Mansour M, Marchlinski FE, McCarthy PM, Mont JL, Morady F, Nademanee K, Nakagawa H, Natale A, Nattel S, Packer DL, Pappone C, Prystowsky E, Raviele A, Reddy V, Ruskin JN, Shemin RJ, Tsao HM, Wilber Wedge D, Prystowsky EN, Damiano R, Jr., Jackman WM, Marchlinski F, McCarthy P, Wilber D, Ad N, Cummings J, Gillinov AM, Heidbuchel H, January C, Lip G, Markowitz S, Nair M, Ovsyshcher IE, Pak HN, Tsuchiya T, Shah D, Siong TW, Vardas PE. 2012

HRS/EHRA/ECAS Expert Consensus Statement on Catheter and Surgical Ablation of Atrial Fibrillation: Recommendations for Patient Selection, Procedural Techniques, Patient Management and Follow-up, Definitions, Endpoints, and Research Trial Design: A report of the Heart Rhythm Society (HRS) Task Force on Catheter and Surgical Ablation of Atrial Fibrillation. Developed in partnership with the European Heart Rhythm Association (EHRA), a registered branch of the European Society of Cardiology (ESC) and the European Cardiac Arrhythmia Society (ECAS); and in collaboration with the American College of Cardiology (ACC), American Heart Association (AHA), the Asia Pacific Heart Rhythm Society (APHRS), and the Society of Thoracic Surgeons (STS). Endorsed by the governing bodies of the American College of Cardiology Foundation, the American Heart Association, the European Cardiac Arrhythmia Society, the European Heart Rhythm Association, the Society of Thoracic Surgeons, the Asia Pacific Heart Rhythm Society, and the Heart Rhythm

Society. Europace. 2012;14(4):528-606.

28. Nademanee K, McKenzie J, Kosar E, Schwab M, Sunsaneewitayakul B, Vasavakul T, Khunnawat C, Ngarmukos T. A new approach for catheter ablation of atrial

fibrillation: mapping of the electrophysiologic substrate. J Am Coll Cardiol. 2004;43(11):2044-2053.

29. Hayward RM, Upadhyay GA, Mela T, Ellinor PT, Barrett CD, Heist EK, Verma A, Choudhry NK, Singh JP. Pulmonary vein isolation with complex fractionated atrial

electrogram ablation for paroxysmal and nonparoxysmal atrial fibrillation: A metaanalysis. Heart Rhythm.2011;8(7):994-1000.

30. Katritsis D, Giazitzoglou E, Sougiannis D, Voridis E, Po SS. Complex fractionated atrial electrograms at anatomic sites of ganglionated plexi in atrial fibrillation.

Europace. 2009;11(3):308-315. 317

31. Pokushalov E, Romanov A, Katritsis DG, Artyomenko S, Shirokova N, Karaskov A, Mittal S, Steinberg JS. Ganglionated plexus ablation vs linear ablation in patients

undergoing pulmonary vein isolation for persistent/long-standing persistent atrial fibrillation: a randomized comparison. Heart Rhythm. 2013;10(9):1280-1286.

32. Wu J, Estner H, Luik A, Ucer E, Reents T, Pflaumer A, Zrenner B, Hessling G, Deisenhofer I. Automatic 3D mapping of complex fractionated atrial electrograms (CFAE) in patients with paroxysmal and persistent atrial fibrillation. J Cardiovasc Electrophysiol. 2008;19(9):897-903.

33. Bosch RF, Zeng X, Grammer JB, Popovic K, Mewis C, Kuhlkamp V. Ionic mechanisms of electrical remodeling in human atrial fibrillation. Cardiovasc Res. 1999;44(1):121-131.

34. Wang Z, Lu Y, Yang B. MicroRNAs and atrial fibrillation: new fundamentals. Cardiovasc Res. 2011;89(4):710-721.

Ravens U, Dobrev D. Left-to-right atrial inward rectifier potassium current gradients in patients with paroxysmal versus chronic atrial fibrillation. Circ Arrhythm

Electrophysiol. 2010;3(5):472-480.

36. Voigt N, Maguy A, Yeh YH, Qi X, Ravens U, Dobrev D, Nattel S. Changes in I K, ACh single-channel activity with atrial tachycardia remodelling in canine atrial

cardiomyocytes. Cardiovasc Res. 2008;77(1):35-43.

37. Makary S, Voigt N, Maguy A, Wakili R, Nishida K, Harada M, Dobrev D, Nattel S. Differential protein kinase C isoform regulation and increased constitutive activity of acetylcholine-regulated potassium channels in atrial remodeling. Circ Res.

2011;109(9):1031-1043.

38. Sarmast F, Kolli A, Zaitsev A, Parisian K, Dhamoon AS, Guha PK, Warren M, Anumonwo JM, Taffet SM, Berenfeld O, Jalife J. Cholinergic atrial fibrillation: I(K,ACh) gradients determine unequal left/right atrial frequencies and rotor dynamics. Cardiovasc Res. 2003;59(4):863-873.

39. Yagi T, Pu J, Chandra P, Hara M, Danilo P, Jr., Rosen MR, Boyden PA. Density and function of inward currents in right atrial cells from chronically fibrillating canine atria. Cardiovasc Res. 2002;54(2):405-415.

40. Workman AJ, Kane KA, Rankin AC. The contribution of ionic currents to changes in refractoriness of human atrial myocytes associated with chronic atrial fibrillation.

Cardiovasc Res. 2001;52(2):226-235.

41. Li D, Melnyk P, Feng J, Wang Z, Petrecca K, Shrier A, Nattel S. Effects of experimental heart failure on atrial cellular and ionic electrophysiology. Circulation. 2000;101(22):2631-2638.

42. Vasquez C, Benamer N, Morley GE. The cardiac fibroblast: functional and electrophysiological considerations in healthy and diseased hearts. J Cardiovasc Pharmacol. 2011;57(4):380-388.

43. Souders CA, Bowers SL, Baudino TA. Cardiac fibroblast: the renaissance cell. Circ Res. 2009;105(12):1164-1176.

44. Xie Y, Garfinkel A, Camelliti P, Kohl P, Weiss JN, Qu Z. Effects of fibroblastmyocyte coupling on cardiac conduction and vulnerability to reentry: A computational

study. Heart Rhythm. 2009;6(11):1641-1649.

45. Tan AY, Li H, Wachsmann-Hogiu S, Chen LS, Chen PS, Fishbein MC. Autonomic innervation and segmental muscular disconnections at the human pulmonary veinatrial junction: implications for catheter ablation of atrial-pulmonary vein junction. J

Am Coll Cardiol. 2006;48(1):132-143.

46. Shen MJ, Choi EK, Tan AY, Lin SF, Fishbein MC, Chen LS, Chen PS. Neural mechanisms of atrial arrhythmias. Nat Rev Cardiol. 2011;9(1):30-39.

47. Kneller J, Zou R, Vigmond EJ, Wang Z, Leon LJ, Nattel S. Cholinergic atrial fibrillation in a computer model of a two-dimensional sheet of canine atrial cells with realistic ionic properties. Circ Res. 2002;90(9):E73-87.

48. Gould PA, Yii M, McLean C, Finch S, Marshall T, Lambert GW, Kaye DM. Evidence for increased atrial sympathetic innervation in persistent human atrial fibrillation.

Pacing Clin Electrophysiol. 2006;29(8):821-829.

49. Mommersteeg MT, Christoffels VM, Anderson RH, Moorman AF. Atrial fibrillation: a developmental point of view. Heart Rhythm. 2009;6(12):1818-1824.

50. Fox CS, Parise H, D'Agostino RB, Sr., Lloyd-Jones DM, Vasan RS, Wang TJ, Levy D, Wolf PA, Benjamin EJ. Parental atrial fibrillation as a risk factor for atrial

fibrillation in offspring. JAMA. 2004;291(23):2851-2855.

51. Nabauer M, Gerth A, Limbourg T, Schneider S, Oeff M, Kirchhof P, Goette A, Lewalter T, Ravens U, Meinertz T, Breithardt G, Steinbeck G. The Registry of the German Competence NETwork on Atrial Fibrillation: patient characteristics and initial management. Europace. 2009;11(4):423-434.

52. Nieuwlaat R, Prins MH, Le Heuzey JY, Vardas PE, Aliot E, Santini M, Cobbe SM, Widdershoven JW, Baur LH, Levy S, Crijns HJ. Prognosis, disease progression, and treatment of atrial fibrillation patients during 1 year: follow-up of the Euro Heart Survey on atrial fibrillation. Eur Heart J. 2008;29(9):1181-1189.

53. Zhang YY, Qiu C, Davis PJ, Jhaveri M, Prystowsky EN, Kowey P, Weintraub WS. Predictors of Progression of Recently Diagnosed Atrial Fibrillation in REgistry on Cardiac Rhythm DisORDers Assessing the Control of Atrial Fibrillation (RecordAF)- United States Cohort. Am J Cardiol. 2013;112(1):79-84.

54. Ruigomez A, Johansson S, Wallander MA, Garcia Rodriguez LA. Predictors and prognosis of paroxysmal atrial fibrillation in general practice in the UK. BMC Cardiovasc Disord. 2005;5:20.

55. Liu XP, Xu X, Tian Y, Tang RB, Yu RH, Long DY, Sang CH, Jiang CX, Ning M, Dong JZ, Ma CS. Morphologies of the atria and pulmonary veins in relation to lone atrial fibrillation progression: a dual-source computed tomography scan study. J Cardiovasc Electrophysiol. 2012;23 Suppl 1:S29-35.

56. Jongnarangsin K, Suwanagool A, Chugh A, Crawford T, Good E, Pelosi F, Jr., Bogun F, Oral H, Morady F. Effect of catheter ablation on progression of paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol. 2012;23(1):9-14.

57. Weerasooriya R, Khairy P, Litalien J, Macle L, Hocini M, Sacher F, Lellouche N, Knecht S, Wright M, Nault I, Miyazaki S, Scavee C, Clementy J, Haissaguerre M, Jais P. Catheter ablation for atrial fibrillation: are results maintained at 5 years of followup? J Am Coll Cardiol. 2011;57(2):160-166.

58.Van Gelder IC, Hagens VE, Bosker HA, Kingma JH, Kamp O, Kingma T, Said SA, Darmanata JI, Timmermans AJ, Tijssen JG, Crijns HJ. A comparison of rate control and rhythm control in patients with recurrent persistent atrial fibrillation. N Engl J Med. 2002;347(23):1834-1840.

59.Pappone C, Radinovic A, Manguso F, Vicedomini G, Ciconte G, Sacchi S, Mazzone P, Paglino G, Gulletta S, Sala S, Santinelli V. Atrial fibrillation progression and

management: a 5-year prospective follow-up study. Heart Rhythm. 2008;5(11):1501- 1507.

[60] Guenancia C, Garnier F, Mouhat B, Béjot Y, Maillot N, Fichot M, et al. Dépistage implications cliniques de la fibrillation atriale silencieuse. Rev Med Interne2018;39:574–9.

[61] Dilaveris PE, Kennedy HL. Silent atrial fibrillation: epidemiology, diagnosis, andclinical impact. Clin Cardiol 2017;40:413–8.

[62] Kennedy HL. Silent atrial fibrillation: definition, clarification, and unansweredissues. Ann Noninvasive Electrocardiol 2015;20:518–25.

[63] Barbarossa A, Guerra F, Capucci A. Silent atrial fibrillation: a critical review. JAtr Fibrillation 2014;7:1138.

[64] Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, Casadei B, et al. 2016 ESCGuidelines for the management of atrial fibrillation developed in collabora-tion with EACTS: The Task Force for the management of atrial fibrillationof the European Society of Cardiology (ESC)Developed with the specialcontribution of the European Heart Rhythm Association (EHRA) of the ESCEn-dorsed by the European Stroke Organisation (ESO). Eur Heart J 2016;37:2893–962.

[65] Camm AJ, Lip GY, De Caterina R, Savelieva I, Atar D, Hohnloser SH, et al.2012 focused update of the ESC Guidelines for the management of atrial fibril-lation: an update of the 2010 ESC Guidelines for the management of atrialfibrillation. Developed with the special contribution of the European HeartRhythm Association. Eur Heart J 2012;33:2719–47.

[66] Lafuente-Lafuente C, Valembois L, Bergmann JF, Belmin J. Antiarrhythmics formaintaining sinus rhythm after cardioversion of atrial fibrillation. CochraneDatabase Syst Rev 2015. CD005049

67. Cox JL, Canavan TE, Schuessler RB, Cain ME, Lindsay BD, Stone C, Smith PK, Corr PB, Boineau JP. The surgical treatment of atrial fibrillation. Ii. Intraoperative electrophysiologic

mapping and description of the electrophysiologic basis of atrial flutter and atrial fibrillation. J Thorac Cardiovasc Surg. 1991;101:406-426

68. Cox JL. Atrial fibrillation ii: Rationale for surgical treatment. J Thorac Cardiovasc Surg. 2003;126:1693-1699

69. Cox JL. Surgical treatment of atrial fibrillation: A review. Europace. 2004;5 Suppl 1:S20

70-Damiano RJ, Jr., Gaynor SL, Bailey M, Prasad S, Cox JL, Boineau JP, Schuessler RP. The long-term outcome of patients with coronary disease and atrial fibrillation undergoing the cox maze procedure. J Thorac Cardiovasc Surg. 2003;126:2016-2021

71-Defauw JJ, Guiraudon GM, van Hemel NM, Vermeulen FE, Kingma JH, de Bakker JM. Surgical therapy of paroxysmal atrial fibrillation with the "corridor" operation. Ann Thorac Surg. 1992;53:564-570; discussion 571

72-van Hemel NM, Defauw JJ, Kingma JH, Jaarsma W, Vermeulen FE, de Bakker JM, Guiraudon GM. Long-term results of the corridor operation for atrial fibrillation. Br Heart J. 1994;71:170-176

73-Sueda T, Imai K, Orihashi K, Watari M, Okada K. Pulmonary vein orifice isolation for elimination of chronic atrial fibrillation. Ann Thorac Surg. 2001;71:708-710

74-Kottkamp H, Hindricks G, Autschbach R, Krauss B, Strasser B, Schirdewahn P, Fabricius A, Schuler G, Mohr FW. Specific linear left atrial lesions in atrial fibrillation: Intraoperative radiofrequency ablation using minimally invasive surgical techniques. J Am Coll Cardiol. 2002;40:475-480

75-Schopka S, Schmid C, Keyser A, Kortner A, Tafelmeier J, Diez C, Rupprecht L, Hilker M. Ablation of atrial fibrillation with the epicor system: A prospective observational trial to evaluate safety and efficacy and predictors of success. J Cardiothorac Surg. 2010;5:34

76-Maessen JG, Nijs JF, Smeets JL, Vainer J, Mochtar B. Beating-heart surgical treatment of atrial fibrillation with microwave ablation. Ann Thorac Surg. 2002;74:S1307-1311

77-Ninet J, Roques X, Seitelberger R, Deville C, Pomar JL, Robin J, Jegaden O, Wellens F, Wolner E, Vedrinne C, Gottardi R, Orrit J, Billes MA, Hoffmann DA, Cox JL, Champsaur GL. Surgical ablation of atrial fibrillation with off-pump, epicardial, high-intensity focused ultrasound: Results of a multicenter trial. J Thorac Cardiovasc Surg. 2005;130:803-809

78-Saoudi N, Mouton-Schleiffer D, Letac B. Direct catheter fulguration of atrial flutter. Lancet. 1987;2:568-569

79-Packer DL, Asirvatham S, Munger TM. Progress in nonpharmacologic therapy of atrial fibrillation. J Cardiovasc Electrophysiol. 2003;14:S296-309

80-Haissaguerre M, Jais P, Shah DC, Gencel L, Pradeau V, Garrigues S, Chouairi S, Hocini M, Le Metayer P, Roudaut R, Clementy J. Right and left atrial radiofrequency catheter therapy of paroxysmal atrial fibrillation. J Cardiovasc Electrophysiol. 1996;7:1132-1144

81- Jais P, Shah DC, Haissaguerre M, Takahashi A, Lavergne T, Hocini M, Garrigue S, Barold SS, Le Metayer P, Clementy J. Efficacy and safety of septal and left-atrial linear ablation for atrial fibrillation. Am J Cardiol. 1999;84:139R-146R

82. Jais P, Shah DC, Haissaguerre M, Hocini M, Peng JT, Takahashi A, Garrigue S, Le Metayer P, Clementy J. Mapping and ablation of left atrial flutters. Circulation. 2000;101:2928-2934

83-Haissaguerre M, Shah DC, Jais P, Hocini M, Yamane T, Deisenhofer I, Chauvin M, Garrigue S, Clementy J. Electrophysiological breakthroughs from the left atrium to the pulmonary veins. Circulation. 2000;102:2463-2465

84-Haissaguerre M, Jais P, Shah DC, Garrigue S, Takahashi A, Lavergne T, Hocini M, Peng JT, Roudaut R, Clementy J. Electrophysiological end point for catheter ablation of atrial fibrillation initiated from multiple pulmonary venous foci. Circulation. 2000;101:1409-1417

85-Pappone C, Oreto G, Rosanio S, Vicedomini G, Tocchi M, Gugliotta F, Salvati A, Dicandia C, Calabro MP, Mazzone P, Ficarra E, Di Gioia C, Gulletta S, Nardi S, Santinelli V, Benussi S, Alfieri O. Atrial electroanatomic remodeling after circumferential radiofrequency pulmonary

vein ablation: Efficacy of an anatomic approach in a large cohort of patients with atrial fibrillation. Circulation. 2001;104:2539-2544

86-Pappone C, Rosanio S, Oreto G, Tocchi M, Gugliotta F, Salvati A, Dicandia C, Mazzone P,