Surgical Management of Atrial Fibrillation in Patients Undergoing Myectomy for Obstructive Hypertrophic Cardiomyopathy

This article is part of CTSNet’s Guest Editor Series, “Operative Management of Obstructive Hypertrophic Cardiomyopathy—Gold Standard Septal Myectomy to Stand the Test of Time.” Guest editor Eduard Quintana has curated a robust collection of content that shares the knowledge, techniques, and insights of several distinguished experts from around the world. See the full series here. 

This video provides an overview of the prevalence and clinical impact of atrial fibrillation in patients with obstructive hypertrophic cardiomyopathy (HCM) presenting for septal myectomy and describes an approach to surgical management of these patients and the corresponding operative techniques.  

The video emphasizes the importance of choosing the appropriate surgical technique based on atrial fibrillation's symptomatic burden and characteristics. Essential steps and details of surgical techniques for pulmonary vein isolation and the Cox-maze III procedure are highlighted. The authors prefer to exclude the left atrial appendage in all patients with a history of atrial fibrillation, and this is accomplished in most patients by amputating the appendage. These ablative procedures are done before septal myectomy to minimize retraction on the heart and damage to the ventricle.  

The video on septal myectomy highlights the importance of ensuring complete relief of outflow tract obstruction after visualizing the distal part of the septum by depressing the ventricles with a sponge stick to rotate the heart posteriorly and extending the myectomy toward the apex as needed. 

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