AF is the most common of all cardiac arrhythmias and accounts for nearly one-third of all hospital admissions due to heart rhythm irregularities. In the United States, nearly 2.3 million people suffer from AF2. The prevalence of AF increases with age, afflicting 4% of the population over 60 years old and nearly 9% of persons 80 years and older. With the aging population in this country, AF will be an even larger public health problem in the future. A recent study predicted that the number of Americans diagnosed with AF will grow to over 10 million by the year 2050. Our previous work has led to the development of an anatomic approach for the treatment of AF called the Cox-Maze (CM) procedure. Despite the high degree of efficacy of the operation, with cure rates greater than 90%, it is clear that the procedure is inadequate for some patients, particularly those with large left atria. Furthermore, approximately 20% of patients remain on antiarrhythmic drugs, reducing the drug free cure rate to ~70%. On the other hand, our studies and those of other laboratories have shown that a more limited lesion set can cure AF in certain patient subsets, indicating that some of lesions used in the CM procedure are unnecessary for some patients. The shortcomings of our current surgical procedure call for a new strategy for this arrhythmia and testify to the inadequacy of a single anatomically- based approach for all patients with AF. The overall objective of this grant during the proposed funding period is to improve the efficacy of AF surgery and to minimize its detrimental physiological consequences. The cure rate of AF surgery will be improved by embarking on a novel new operative strategy, by developing a patient- specific lesion set based on an individual patient's anatomy and electrophysiology. These goals will be achieved by the following specific aims: 1: To non-invasively assess mechanisms of AF preoperatively using Electrocardiographic Imaging (ECGI);2: To develop and test novel patient specific lesion sets based on the critical mass hypothesis and the specific electrophysiological characteristics of the patient's arrhythmia;3: To develop accurate techniques to evaluate the consequences of AF and surgical ablation on left and right atrial function, both experimentally and clinically. This will allow precise assessment of the hemodynamic consequences of surgery for AF and allow for the development of less damaging procedures.

Public Health Relevance

Atrial fibrillation affects over two million Americans and drug therapy is ineffective. Previously, this grant has resulted in the development of a curative procedure called the Cox-Maze procedure. The present proposal is design to improve and simplify this surgical treatment, maintain the high cure rate, and minimize the effects on heart function, thus making it available to a wider patient population.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Research Project (R01)
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Bioengineering, Technology and Surgical Sciences Study Section (BTSS)
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Boineau, Robin
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Washington University
Schools of Medicine
Saint Louis
United States
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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; 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
Musharbash, Farah N; Schill, Matthew R; Henn, Matthew C et al. (2017) Minimally Invasive Septal Myectomy for Hypertrophic Obstructive Cardiomyopathy. Innovations (Phila) 12:489-492
Schill, Matthew R; Sinn, Laurie A; Greenberg, Jason W et al. (2017) A Minimally Invasive Stand-alone Cox-Maze Procedure Is as Effective as Median Sternotomy Approach. Innovations (Phila) 12:186-191
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

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