Maze 3 for XXXX : two cuts too few?

@entity1 @entity406 @entity955 @entity299 @entity715 @entity13169 @entity130
The Maze procedure has been developed as a surgical approach to the management of @entity1 with @entity955 refractory to medical treatment. The recent modification of the technique (Maze 3) achieves good rate control with coordinated AV contractions. However, the procedure involves cuts that completely isolate a block of left atrial (LA) wall, including the four ostia of the pulmonary veins. The electrical and mechanical activity of this isolated @entity13169 are dissociated from the rest of the atrium, and the area may, in fact, continue to fibrillate. This may provide a nidus for the development of @entity715 . The weight and endocardial surface area of the @entity13169 and of the entire LA were estimated in ten @entity406 fixed hearts from @entity130 victims with no evidence of @entity299 . In these samples, the @entity13169 represented 35% of the endocardial surface area of the entire LA and 29% of the weight. The @entity13169 is of sufficient size to allow macroreentrant circuits to form and has the potential to fibrillate if isolated from the rest of the atrium. We modified the Maze 3 procedure to recruit the otherwise isolated @entity13169 by using two additional cuts around each pair of pulmonary veins as they enter the LA. The first @entity1 who underwent the modified procedure demonstrated sinus rhythm on Holter monitoring postoperatively and remained in sinus rhythm following burst atrial pacing at 300 and 420 beats/min each for 30 seconds. In addition, atrial contractions were found to contribute 19% of the cardiac output.(ABSTRACT TRUNCATED AT 250 WORDS)
