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Better Outcomes Using 'Box' Lesion for Atrial Fibrillation

Less atrial tachyarrhythmias, less recurrence of atrial fibrillation, lower drug use

FRIDAY, April 18 (HealthDay News) -- Connecting the pulmonary veins by two lesions (the "box" lesion) rather than one to isolate the posterior left atrium in patients undergoing the Cox maze procedure for atrial fibrillation is associated with less early atrial tachyarrhythmias, less recurrence of atrial fibrillation and lower use of anti-arrhythmic drugs, according to a report in the April issue of the Journal of Thoracic and Cardiovascular Surgery.

Rochus K. Voeller, M.D., and colleagues from Washington University School of Medicine in St. Louis, compared surgical outcomes in 137 patients who underwent the Cox maze procedure for atrial fibrillation. Of these, 56 had the pulmonary veins connected by a single bipolar radiofrequency ablation lesion and 81 had a box lesion of two connecting lesions.

After a mean follow-up of 11.8 months, the researchers found that the box lesion group had significantly less early atrial tachyarrhythmia (37 versus 71 percent), significantly more freedom from recurrence of atrial fibrillation (96 versus 85 percent at three months) and lower use of anti-arrhythmic drugs (15 versus 44 percent at six months).

"Isolating the entire posterior left atrium by creating a box lesion instead of a single connecting lesion between the pulmonary veins showed a significantly lower incidence of early atrial tachyarrhythmias, higher freedom from atrial fibrillation recurrence at one and three months, and lower use of anti-arrhythmic drugs at three and six months," Voeller and colleagues conclude.

Several of the study authors report financial relationships to the pharmaceutical and medical equipment industries.

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