Atrial fibrillation (AF) is the most common arrhythmia in the world, and a significant source of morbidity and mortality. Unfortunately, antiarrhythmic drugs have had limited efficacy and numerous side effects. Transvenous ablation techniques require prolonged, often multiple, procedures and have had high complication rates and questionable long-term efficacy. Over the last two decades, our laboratory has developed two successful surgical approaches for the treatment of AF. The Maze and Radial procedures have the best-documented long-term results in the treatment of atrial fibrillation, with over 90% of patients remaining arrhythmia-free at 10 years. Despite their proven efficacy, few surgeons around the world actually perform these procedures, both because of their invasiveness and complexity. Moreover, these operations are far from perfect, and still result in significant morbidity in terms of postoperative atrial arrhythmias, conduction disturbances, and atrial dysfunction. Our goal in this competing renewal is to develop a less invasive procedure with more widespread applicability by moving from an anatomically based operation that was designed to eliminate all possible mechanisms of AF to a mapping-directed procedure that addresses the specific focal mechanisms responsible for AF in each particular patient. To accomplish this goal and to evaluate the physiologic consequences of our interventions, the following specific aims are proposed: 1) Develop a real-time algorithm using intraoperative epicardial mapping to identify focal sources and substrates for AF to allow for mapping-directed therapy. 2) Develop less-invasive surgical procedures for the treatment of AF based on real time mapping data and the assessment of the physiological consequences and mechanistic insight from the operations. 3) Develop techniques to evaluate atrial function non-invasively to allow for the precise assessment of the hemodynamic consequences of surgery for AF. 4) Determine the causes of postoperative arrhythmias associated with surgical procedures to ablate AF, and modify these procedures to minimize their occurrence. If we can achieve these aims, the thousands of chronic AF patients yearly who undergo valvular and coronary surgery will have their arrhythmia cured in the operating room at the time of surgery, and our surgical treatment will become a viable option to a lifetime of anti-arrhythmic drug therapy and anticoagulation for millions of patients with lone AF.
| 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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