ISMIC 2004 Commentary summaries Dr Masroor

1
What are the take home messages from ISMICS for
the surgeon interested in surgical control of
ablation?

• Its clear that cut and sew Maze will not be
  widely accepted despite its good results, and
  some minimally invasive approach using
  thoracoscopy, mini-thoracotomy, or robotic
  assistance will be needed to attract people for
  surgery
• Results are still coming in as to which energy
  source gives the best results
• Do the best possible lesion set (as close to the
  Maze as you can) using an alternate energy
  source, through a small incision

2
What are the major strengths and limitations of
cryo?

• The biggest strength of Cryo is that we know it
  works, and is as good as cut and sew Maze
• Argon-based systems have not been around long, so
  we need to do more work to be certain of the
  safety profile
• Off-pump beating-heart ablation through a
  minimally invasive approach continues to elude us
  
• Off-pump through a clamp device can be done but
  the results arent as good

3
What is the importance of a minimally invasive
approach?

• People with only atrial fibrillation will not go
  through a sternotomy to get an operation unless
  they are dying from this disease
• To offer this therapy to patients, its very
  important to do it without an incision, or
  through a very small incision, and to do it
  safely without using cardiopulmonary bypass

4
Is there an ideal lesion pattern?

• Certainly a need to find an ideal lesion pattern
• Data that came out of the Cleveland Clinic
  studied 3 different lesion sets in 100 patients
  each and so now we have some idea of what works,
  and what does not
• The importance of the right-sided lesion sets
  needs to be assessed
• We need to define a set of lesion sets that we
  should all follow in a trial situation

5
What is the next major question that needs to be
answered in the field?

• What lesion set works?
• How much can it really be simplified?
• Need to define what lesion sets are absolutely
  essential to achieve a greater than 90 success
  rate

6
Why arent more atrial fibrillation surgeries
being done?

• No minimally invasive approach is a major barrier
• Education People dont realize that atrial
  fibrillation is a significant disease with
  significant morbidity
• Many practitioners still think that its a benign
  disease, so educating people and physicians is
  important