This renewal application requests five years' support for work now in continuous progress for over 15 years at Washington University. Dr. John Boineau, the new PI, has replaced Dr. James Cox, the former P1, who transferred to Georgetown University Hospital. Dr. Cox remains as a special consultant. The broad aims continue to be the direct or surgical ablation of cardiac arrhythmias. The emphasis of the current renewal is focused upon the development of a new procedure, the radial incisions approach (RIA), to eradicate atrial fibrillation (AF) and restore atrial transport function and is directed primarily toward patients undergoing surgery for valvular or ischemic heart disease. Conventional valve or CABG surgery does not eliminate and may not prevent AF in these patients. The availability of an effective means of eradicating this arrhythmia in these patients at the time of surgery would permit control of rate and rhythm, limit embolic stroke, and improve cardiac performance, outcome, and the quality of life. Whereas the Maze and RIA assume randomly distributed and changing reentry which are eliminated without prior activation mapping, new data indicate that some forms of AF result from (spatially) stable reentry which can be identified by new mapping methods and focally ablated. Thus, a second project is directed toward map guided, focal cryoablation of AF. This could be performed off bypass as a more limited and rapid alternative to the more extensive and (bypass) time consuming RIA procedure. A third project is targeted at prevention and correction of postoperative atrial flutter (AFL) after the Fontan operation in congenital heart patients or after lung transplant surgery. Studies will be performed in both realistic animal models with atrial enlargement and patients with AF and AFL and will center about the use of new automated, 3-D mapping techniques and rapid numerical analysis of potentials recorded simultaneously from to 512 electrodes during the arrhythmias. Preliminary observations indicate that the proposed studies are feasible, will provide new information regarding the different mechanisms of AF and AFL that are related to atrial enlargement and/or atrial surgery, and this data will be used to develop the new surgical ablation techniques to control or prevent these arrhythmias.
| Khiabani, Ali J; Adademir, Taylan; Schuessler, Richard B et al. (2018) Management of Atrial Fibrillation in Patients Undergoing Coronary Artery Bypass Grafting: Review of the Literature. Innovations (Phila) 13:383-390 |
| Musharbash, Farah N; Schill, Matthew R; Hansalia, Vivek H et al. (2018) Minimally Invasive Versus Full-Sternotomy Septal Myectomy for Hypertrophic Cardiomyopathy. Innovations (Phila) 13:261-266 |
| Musharbash, Farah N; Schill, Matthew R; Sinn, Laurie A et al. (2018) Performance of the Cox-maze IV procedure is associated with improved long-term survival in patients with atrial fibrillation undergoing cardiac surgery. J Thorac Cardiovasc Surg 155:159-170 |
| Ruaengsri, Chawannuch; Schill, Matthew R; Khiabani, Ali J et al. (2018) The Cox-maze IV procedure in its second decade: still the gold standard? Eur J Cardiothorac Surg 53:i19-i25 |
| Schill, Matthew R; Melby, Spencer J; Speltz, Molly et al. (2017) Evaluation of a Novel Cryoprobe for Atrial Ablation in a Chronic Ovine Model. Ann Thorac Surg 104:1069-1073 |
| Badhwar, Vinay; Rankin, J Scott; Damiano Jr, Ralph J et al. (2017) The Society of Thoracic Surgeons 2017 Clinical Practice Guidelines for the Surgical Treatment of Atrial Fibrillation. Ann Thorac Surg 103:329-341 |
| Ishii, Yosuke; Schuessler, Richard B; Gaynor, Sydney L et al. (2017) Postoperative atrial fibrillation: The role of the inflammatory response. J Thorac Cardiovasc Surg 153:1357-1365 |
| Lawrance, Christopher P; Henn, Matthew C; Miller, Jacob R et al. (2017) The Electrophysiologic Effects of Acute Mitral Regurgitation in a Canine Model. Ann Thorac Surg 103:1277-1284 |
| Ad, Niv; Damiano Jr, Ralph J; Badhwar, Vinay et al. (2017) Expert consensus guidelines: Examining surgical ablation for atrial fibrillation. J Thorac Cardiovasc Surg 153:1330-1354.e1 |
| Schill, Matthew R; Musharbash, Farah N; Hansalia, Vivek et al. (2017) Late results of the Cox-maze IV procedure in patients undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg 153:1087-1094 |
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