Five‐year results of a modified left atrial maze IV procedure in the treatment of atrial fibrillation: a randomized study

Figure 1. (a) The left atrial maze IV (LAM‐IV) procedure lesion set and (b) the modified LAM‐IV (MLAM‐IV) procedure lesion set.

Figure 2. The MLAM‐IV procedure. Through a small incision in the superior right PV antrum (a, arrow), the anterior wall of the right‐sided PVs is ablated (b); the ligament of Marshall is dissected (c, arrow), and the LA roof line between the superior PVs is created (c). The incision in the superior right PV is also used as the LA aspirator (d, arrow). The LAA is amputated (e), connecting the lesion from the LAA to the LA roof line (f); a lesion is created on the anterior wall of the left‐sided PVs through the LAA incision (g). The LA floor lesion between the inferior PVs is created (i) through an incision (h, arrow), connecting the lesion from the right inferior PV to the mitral annulus. LA, left atrial; LAA, left atrial appendage; MLAM‐IV, the modified left atrial maze IV; PV, pulmonary vein.

Figure 3. Freedom from AF recurrence in patients who underwent the MLAM‐IV (blue bars) versus the LAM‐IV (red bars). Kaplan–Meier overall survival curves for patients with LAM‐IV versus MLAM‐IV procedure (a). Kaplan–Meier AF free survival curves for patients with LAM‐IV versus MLAM‐IV procedure (b). The rate of freedom from AF group was slightly higher, but not significantly so, in the MLAM‐IV group from 1 to 5 years. The largest difference in freedom from AF was observed at 5‐year follow‐up (c). AF, atrial fibrillation; LAM‐IV, the left atrial maze IV; MLAM‐IV, the modified left atrial maze IV.