2105:
463:, hence a procedure with more careful follow-up will appear to be less successful. In addition, procedures continue to evolve rapidly, so long follow-up data do not accurately reflect current procedural methods. For more recent minimaze procedures, only relatively small and preliminary reports are available. With those caveats in mind, it can be said that reported short-term freedom from
201:
Today, the terms "minimaze", "mini-maze", and "mini maze" are still sometimes used to describe open heart procedures requiring cardiopulmonary bypass and median sternotomy, but more commonly they refer to minimally invasive, epicardial procedures not requiring cardiopulmonary bypass, such as those
157:
lesions the "mini-maze
Procedure" ... None of the present energy sources—including cryotherapy, unipolar radiofrequency, irrigated radiofrequency, bipolar radiofrequency, microwave, and laser energy—are capable of creating the left atrial isthmus lesion from the epicardial surface, because of the
112:
clamps with linear cryoprobes. Cox-Maze IV is now considered to be the "gold standard" for effective surgical cure of AF, but the results are institution dependent. It was quite successful in eliminating AF, but had drawbacks as well. The Cox maze III is sometimes referred to as the "Traditional
1147:
Calkins H, Brugada J, Packer DL, Cappato R, Chen SA, Crijns HJ, Damiano RJ Jr, Davies DW, Haines DE, Haissaguerre M, Iesaka Y, Jackman W, Jais P, Kottkamp H, Kuck KH, Lindsay BD, Marchlinski FE, McCarthy PM, Mont JL, Morady F, Nademanee K, Natale A, Pappone C, Prystowsky E, Raviele A, Ruskin JN,
1148:
Shemin RJ (2007). "HRS/EHRA/ECAS expert
Consensus Statement on catheter and surgical ablation of atrial fibrillation: recommendations for personnel, policy, procedures and follow-up. A report of the Heart Rhythm Society (HRS) Task Force on catheter and surgical ablation of atrial fibrillation".
426:
of AF, and the patient selection criteria are similar. Patients are considered for minimaze procedures if they have moderate or severe symptoms and have failed medical therapy; asymptomatic patients are generally not considered. Those most likely to have a good outcome have paroxysmal
170:
Although Dr. Cox's 2004 definition specifically excludes an epicardial approach to eliminate AF, he and others pursued this important goal, and the meaning of the term changed as successful epicardial procedures were developed. In 2002 Saltman performed a completely
133:(from the outside of the heart), so that it could be performed on a normally beating heart, without cardiopulmonary bypass. Until recently this was not thought possible; as recently as 2004, Dr. Cox defined the mini-maze as requiring an
409:
and that the intrinsic cardiac nervous system, which is located in these regions, plays an important role. Supporting this is the finding that targeting these autonomic sites improves the likelihood of successful elimination of AF by
454:
Long-term success of the minimaze procedures awaits a consensus. Attaining a consensus is hindered by several problems; perhaps the most important of these is incomplete or inconsistent post-procedure follow-up to determine if
108:). A series of improvements were made, culminating in 1992 in the Cox maze III procedure, originally a cut-and-sew procedure, but later performed with cryosurgical lesions. In 2002 Maze IV was first used combining
121:
Efforts have since been made to equal the success of the Cox maze III while reducing surgical complexity and likelihood of complications. During the late 1990s, operations similar to the Cox maze, but with fewer
1110:
Krul SP, Driessen AH, de Groot JR (2013). "Navigating the mini-maze: systematic review of the first results and progress of minimally-invasive surgery in the treatment of atrial fibrillation".
487:
Cox J, Schuessler R, D'Agostino H, Stone C, Chang B, Cain M, Corr P, Boineau J (1991). "The surgical treatment of atrial fibrillation. III. Development of a definitive surgical procedure".
1012:
Scherlag B, Nakagawa H, Jackman W, Yamanashi W, Patterson E, Po S, Lazzara R (2005). "Electrical stimulation to identify neural elements on the heart: their role in atrial fibrillation".
198:
energy rather than microwave, and different, slightly larger incisions. In 2005, he published his results in the first 27 patients. This came to be known as the Wolf minimaze procedure.
971:
Pappone C, Santinelli V, Manguso F, Vicedomini G, Gugliotta F, Augello G, Mazzone P, Tortoriello V, Landoni G, Zangrillo A, Lang C, Tomita T, Mesas C, Mastella E, Alfieri O (2004).
887:
Ninet J, Roques X, Seitelberger R, Deville C, Pomar J, Robin J, Jegaden O, Wellens F, Wolner E, Vedrinne C, Gottardi R, Orrit J, Billes M, Hoffmann D, Cox J, Champsaur G (2005).
96:. The intention was to eliminate AF by using incisional scars to block abnormal electrical circuits (atrial macroreentry) that AF requires. This required an extensive series of
298:
The Wolf minimaze requires one 5 cm and two 1 cm incisions on each side of the chest. These incisions allow the surgeon to maneuver the tools, view areas through an
267:
is entered, and two sterile rubber tubes are threaded behind the heart, in the transverse and oblique sinuses. These tubes are joined, then used to guide the flexible
1096:
467:
following the radiofrequency ("Wolf") procedure ranges from 67% to 91% with longer-term results in a similar range, but limited primarily to patients with paroxysmal
459:
has recurred, although many reasons have been considered. It has been clearly demonstrated that longer or more intensive follow-up identifies much more recurrent
326:) that may cause AF may be eliminated as well. Subsequently, the left side of the chest is entered. The ligament of Marshall (a vestigial structure with marked
1267:
Wudel JH, Chaudhuri P, Hiller JJ (2008). "Video-assisted epicardial ablation and left atrial appendage exclusion for atrial fibrillation: extended follow-up".
1344:
451:
A 2013 review found the results of the minimally-invasive mini-maze procedure to be intermediate between the standard maze procedure and catheter ablation.
2053:
1379:
769:
Salenger R, Lahey S, Saltman A (2004). "The completely endoscopic treatment of atrial fibrillation: report on the first 14 patients with early results".
1475:
1313:
1304:
32:
1873:
1463:
1748:
361:
Although the HIFU minimaze is performed epicardially, on the normally beating heart, it is also usually performed in conjunction with other
1185:"Long-term risk of recurrent atrial fibrillation as documented by an implantable monitoring device: implications for optimal patient care"
737:
Saltman A, Rosenthal L, Francalancia N, Lahey S (2003). "A completely endoscopic approach to microwave ablation for atrial fibrillation".
1112:
889:"Surgical ablation of atrial fibrillation with off-pump, epicardial, high-intensity focused ultrasound: results of a multicenter trial"
2127:
1998:
1674:
1579:
1879:
356:
1224:
McClelland JH, Duke D, Reddy R (2007). "Preliminary results of a limited thoracotomy: new approach to treat atrial fibrillation".
613:"The Cox maze III procedure for atrial fibrillation: long-term efficacy in patients undergoing lone versus concomitant procedures"
1337:
259:
The microwave minimaze requires three 5 mm to 1 cm incisions on each side of the chest for the surgical tools and the
166:
annulus. Therefore, the mini-maze procedure cannot be performed epicardially by means of any presently available energy source."
100:(from the inside of the heart) incisions through both atria, a median sternotomy (vertical incision through the breastbone) and
1886:
1693:
527:
405:, hence these regions are thought to be important. A concept gaining support is that paroxysmal AF is mediated in part by the
1986:
1683:
126:
incisions, led to the use of the terms "minimaze", "mini maze" and "mini-maze", although these were still major operations.
2008:
443:
provides technical challenges due to scarring on the outside of the heart, but does not always preclude minimaze surgery.
1509:
973:"Pulmonary vein denervation enhances long-term benefit after circumferential ablation for paroxysmal atrial fibrillation"
1993:
1981:
1862:
439:
are less likely to have a successful result; these procedures are generally not recommended for such patients. Previous
179:
of AF and subsequently published their results in 14 patients. These were performed epicardially, on the beating heart,
296:
Video-assisted
Bilateral Epicardial Bipolar Radiofrequency Pulmonary Vein Isolation and Left Atrial Appendage Excision:
92:, and performed the first one in 1987. "Maze" refers to the series of incisions arranged in a maze-like pattern in the
63:(AF), a common disturbance of heart rhythm. They are procedures derived from the original maze procedure developed by
2132:
2108:
1330:
105:
1633:
257:
Completely
Endoscopic Microwave Ablation of Atrial Fibrillation on the Beating Heart Using Bilateral Thoracoscopy:
243:
in which most clots form (the "appendage") is usually removed, in an effort to reduce the long-term likelihood of
1940:
1830:
1584:
1374:
2019:
2003:
1470:
1453:
811:"Video-assisted bilateral pulmonary vein isolation and left atrial appendage exclusion for atrial fibrillation"
406:
327:
319:
2015:
1957:
1857:
1822:
1668:
2061:
101:
2092:
1896:
1817:
1090:
149:
encircling incision, left atrial isthmus lesion with its attendant coronary sinus lesion, and the right
2066:
1623:
1436:
1431:
1057:"What size of left atrium significantly impairs the success of maze surgery for atrial fibrillation?"
1945:
1923:
1609:
1448:
1421:
468:
464:
460:
456:
142:
89:
60:
1928:
1837:
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1778:
1719:
1640:
1548:
1497:
1411:
1249:
1037:
953:
323:
213:
No cardiopulmonary bypass; instead, these procedures are performed on the normally beating heart.
76:
318:
tissue is heated between the jaws of the clamp, cauterizing the area. The clamp is removed. The
1971:
1917:
1847:
1755:
1743:
1604:
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1492:
1443:
1354:
1284:
1241:
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994:
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746:
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504:
423:
411:
394:
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The mechanism by which AF is eliminated by curative procedures such as the maze, minimaze, or
109:
27:
283:
antenna is withdrawn behind the heart. The lesions form a "box-like" pattern around all four
2071:
1976:
1714:
1644:
1627:
1559:
1532:
1527:
1276:
1233:
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1157:
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984:
937:
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858:
822:
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706:
665:
624:
583:
575:
536:
496:
427:(intermittent) AF, and have a heart that is relatively normal. Those with severely enlarged
184:
141:"In summary, it would appear that placing the following lesions can cure most patients with
1322:
2043:
1965:
1812:
1802:
1788:
1679:
1649:
1555:
1384:
1369:
611:
Prasad S, Maniar H, Camillo C, Schuessler R, Boineau J, Sundt T, Cox J, Damiano R (2003).
440:
402:
382:
374:
362:
343:
335:
311:
284:
187:
was used to make the lesions that had previously been performed by the surgeon's scalpel.
159:
85:
56:
928:
Scherlag B, Po S (2006). "The intrinsic cardiac nervous system and atrial fibrillation".
183:. Their method came to be known as the minimaze or microwave minimaze procedure, because
1950:
1935:
1731:
1708:
1539:
1523:
1458:
989:
972:
941:
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93:
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694:
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653:
629:
612:
500:
2121:
2087:
1807:
1426:
1280:
1237:
862:
809:
Wolf R, Schneeberger E, Osterday R, Miller D, Merrill W, Flege J, Gillinov A (2005).
525:
Cox JL, Churyla A, McCarthy PM (2018). "When Is a Maze
Procedure a Maze Procedure?".
1253:
1041:
957:
1852:
436:
191:
81:
64:
853:
Coumel P (1994). "Paroxysmal atrial fibrillation: a disorder of autonomic tone?".
397:
is controversial. All successful methods destroy tissue in the areas of the left
1125:
2029:
1772:
1736:
1416:
1401:
1161:
905:
888:
827:
810:
264:
233:
134:
97:
1201:
1184:
540:
271:
antenna energy source through the sinuses behind the heart, to position it for
202:
developed by
Saltman, Wolf, and others. These procedures are characterized by:
84:, and associates developed the "maze" or "Cox maze" procedure, an "open-heart"
2024:
1891:
1796:
1564:
1073:
1056:
1025:
366:
229:
216:
Few or no actual incisions into the heart itself. The "maze" lesions are made
172:
695:"The Role of Surgical Intervention in the Management of Atrial Fibrillation"
299:
280:
268:
260:
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1288:
1245:
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1169:
1133:
1082:
1033:
998:
949:
914:
836:
790:
782:
750:
720:
679:
638:
597:
548:
870:
508:
346:, and that the ganglionated plexi are no longer active, may be performed.
1314:
Cardiologic
Interventional Therapy for Atrial and Ventricular Arrhythmias
339:
272:
176:
41:
652:
Szalay Z, Skwara W, Pitschner H, Faude I, Klövekorn W, Bauer E (1999).
330:
activity) is removed. The clamp is subsequently positioned on the left
579:
1688:
342:. Direct testing to demonstrate complete electrical isolation of the
315:
276:
244:
163:
154:
150:
129:
A primary goal has been to perform a curative, "maze-like" procedure
123:
355:
Surgical ablation of atrial fibrillation with off-pump, epicardial,
117:
Minimally invasive epicardial surgical procedures for AF (minimaze)
2037:
1867:
1698:
1543:
1358:
287:
behind the heart. The left atrial appendage is usually removed.
1326:
306:
is exposed first. A clamp-like tool is positioned on the left
210:
and/or "mini-thoracotomy" incisions between the ribs are used.
71:
The origin of the mini-maze procedures: The Cox maze procedure
1183:
Israel C, Grönefeld G, Ehrlich J, Li Y, Hohnloser S (2004).
365:, and so would not be minimally invasive in those cases. An
302:, and to see the heart directly. The right side of the left
1055:
Sunderland, N., Maruthappu, M. & Nagendran, M. (2011).
279:
tissue heated and destroyed in a series of steps as the
1305:
Surgical
Treatment of Supraventricular Tachyarrhythmias
381:
to destroy tissue in the appropriate regions near the
113:
maze", the "cut and sew maze", or simply the "maze".
2080:
2052:
1909:
1764:
1660:
1400:
1393:
181:
without cardiopulmonary bypass or median sternotomy
26:
21:
377:, and intense acoustic energy is directed at the
350:High Intensity Focused Ultrasound (HIFU) minimaze
162:to reach the left atrial wall near the posterior
158:necessity of penetrating through the circumflex
764:
762:
760:
654:"Midterm results after the mini-maze procedure"
389:Mechanism of elimination of atrial fibrillation
369:device is positioned epicardially, on the left
139:
848:
846:
732:
730:
520:
518:
1338:
882:
880:
8:
1095:: CS1 maint: multiple names: authors list (
422:The minimaze procedures are alternatives to
194:, MD and others developed a procedure using
804:
802:
800:
564:"Surgical Treatment of Atrial Fibrillation"
206:No median sternotomy incision; instead, an
1397:
1380:Cardiology diagnostic tests and procedures
1345:
1331:
1323:
1476:Transcatheter pulmonary valve replacement
1200:
1072:
988:
904:
826:
710:
669:
628:
587:
1519:shunt from heart chamber to blood vessel
568:Methodist DeBakey Cardiovascular Journal
153:isthmus lesion. We call this pattern of
1619:shunt from blood vessel to blood vessel
479:
1088:
18:
1749:Valve-sparing aortic root replacement
1488:enlargement of existing septal defect
7:
1483:production of septal defect in heart
1113:International Journal of Cardiology
37:
16:Types of cardiac surgery procedures
1580:transposition of the great vessels
1505:creation of septal defect in heart
990:10.1161/01.CIR.0000112641.16340.C7
942:10.1097/01.hco.0000198980.40390.e4
14:
1880:Cardiac resynchronization therapy
357:high-intensity focused ultrasound
2104:
2103:
1281:10.1016/j.athoracsur.2007.08.014
1238:10.1111/j.1540-8167.2007.00977.x
88:procedure intended to eliminate
1887:Left atrial appendage occlusion
1061:Interact Cardiovasc Thorac Surg
863:10.1093/eurheartj/15.suppl_a.9
528:Canadian Journal of Cardiology
275:. Energy is delivered and the
1:
2009:Radionuclide ventriculography
930:Current Opinion in Cardiology
671:10.1016/S1010-7940(99)00208-0
630:10.1016/S0022-5223(03)01287-X
501:10.1016/S0022-5223(19)36684-X
1994:Myocardial perfusion imaging
1318:Cardiac Surgery in the Adult
1309:Cardiac Surgery in the Adult
1126:10.1016/j.ijcard.2011.10.011
1014:J Interv Card Electrophysiol
59:procedures intended to cure
1226:J Cardiovasc Electrophysiol
1162:10.1016/j.hrthm.2007.04.005
906:10.1016/j.jtcvs.2005.05.014
828:10.1016/j.jtcvs.2005.03.041
2149:
1601:for univentricular defect
1202:10.1016/j.jacc.2003.08.027
541:10.1016/j.cjca.2018.05.008
106:extracorporeal circulation
74:
2128:Cardiac electrophysiology
2101:
1941:Implantable loop recorder
1585:Arterial switch operation
1375:Interventional cardiology
1365:
1074:10.1510/icvts.2011.271999
1026:10.1007/s10840-005-2492-2
401:near the junction of the
38:
2020:Coronary catheterization
1510:Blalock–Hanlon procedure
1471:Mitral valve replacement
1454:Aortic valve replacement
893:J Thorac Cardiovasc Surg
815:J Thorac Cardiovasc Surg
617:J Thorac Cardiovasc Surg
489:J Thorac Cardiovasc Surg
407:autonomic nervous system
2016:Cardiac catheterization
1958:Electrophysiology study
1858:Radiofrequency ablation
1823:Alcohol septal ablation
658:Eur J Cardiothorac Surg
2062:Impedance cardiography
1684:Coronary artery bypass
783:10.1532/HSF98.20041111
435:, or severely leaking
168:
110:bipolar radiofrequency
102:cardiopulmonary bypass
2093:Transcutaneous pacing
1897:Heart transplantation
1818:Ventricular reduction
1634:Blalock–Taussig shunt
239:The part of the left
104:(heart-lung machine;
2067:Ballistocardiography
1624:systemic circulation
857:. 15 Suppl A: 9–16.
190:Shortly thereafter,
53:mini-maze procedures
1946:Cardiac stress test
1924:Electrocardiography
1863:Pacemaker insertion
1610:Kawashima procedure
1574:compound procedures
1449:Aortic valve repair
1422:Mitral valve repair
469:atrial fibrillation
465:atrial fibrillation
461:atrial fibrillation
457:atrial fibrillation
143:atrial fibrillation
90:atrial fibrillation
61:atrial fibrillation
2133:Cardiac procedures
1999:Cardiovascular MRI
1929:Vectorcardiography
1784:Pericardial window
1779:Pericardiocentesis
1720:Drug-eluting stent
1549:Rastelli procedure
1498:Balloon septostomy
1020:(Suppl 1): 37–42.
324:ganglionated plexi
252:Microwave minimaze
77:Cox maze procedure
22:Minimaze procedure
2115:
2114:
1972:Angiocardiography
1918:Electrophysiology
1905:
1904:
1848:Catheter ablation
1831:Conduction system
1756:LeCompte maneuver
1744:Bentall procedure
1605:Norwood procedure
1595:Senning procedure
1590:Mustard procedure
1493:Atrial septostomy
1444:Valve replacement
1189:J Am Coll Cardiol
580:10.14797/VNDG5944
535:(11): 1482–1491.
424:catheter ablation
418:Patient selection
412:catheter ablation
395:catheter ablation
49:
48:
2140:
2107:
2106:
2072:Cardiotocography
2040:
2004:Ventriculography
1977:Echocardiography
1968:
1920:
1836:Maze procedure (
1833:
1799:
1775:
1728:
1727:Obstacle removal
1715:Bare-metal stent
1711:
1671:
1628:pulmonary artery
1620:
1575:
1560:pulmonary artery
1533:Fontan procedure
1528:pulmonary artery
1520:
1484:
1398:
1347:
1340:
1333:
1324:
1293:
1292:
1264:
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1002:
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850:
841:
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830:
806:
795:
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771:Heart Surg Forum
766:
755:
754:
739:Heart Surg Forum
734:
725:
724:
714:
699:Tex Heart Inst J
690:
684:
683:
673:
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643:
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632:
608:
602:
601:
591:
562:Wolf RK (2021).
559:
553:
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522:
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512:
484:
447:Surgical results
185:microwave energy
145:of either type:
42:edit on Wikidata
19:
2148:
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2141:
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2138:
2137:
2118:
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2097:
2076:
2048:
2044:Phonocardiogram
2036:
1966:Cardiac imaging
1964:
1916:
1901:
1829:
1813:Septal myectomy
1803:Cardiomyoplasty
1795:
1789:Pericardiectomy
1771:
1760:
1726:
1707:
1667:
1661:Cardiac vessels
1656:
1650:Glenn procedure
1618:
1573:
1556:right ventricle
1518:
1482:
1404:
1389:
1385:Cardiac imaging
1370:Cardiac surgery
1361:
1351:
1301:
1296:
1269:Ann Thorac Surg
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1265:
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1218:
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486:
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477:
449:
441:cardiac surgery
420:
403:pulmonary veins
391:
383:pulmonary veins
375:pulmonary veins
363:cardiac surgery
352:
344:pulmonary veins
336:pulmonary veins
312:pulmonary veins
310:near the right
293:
285:pulmonary veins
254:
192:Randall K. Wolf
160:coronary artery
119:
86:cardiac surgery
79:
73:
57:cardiac surgery
45:
17:
12:
11:
5:
2146:
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2054:Function tests
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2013:
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2011:
2001:
1996:
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1951:Bruce protocol
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1936:Holter monitor
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1734:
1732:Endarterectomy
1729:
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1709:Coronary stent
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1299:External links
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821:(3): 797–802.
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693:Cox J (2004).
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433:cardiomyopathy
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334:near the left
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232:energy, or by
222:radiofrequency
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196:radiofrequency
147:pulmonary vein
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75:Main article:
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1427:Valvuloplasty
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777:(6): E555–8.
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745:(3): E38–41.
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495:(4): 569–83.
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82:James Cox, MD
78:
70:
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65:James Cox, MD
62:
58:
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43:
34:
31:
29:
25:
20:
1876:implantation
1870:implantation
1853:Cryoablation
1841:
1694:Off-pump CAB
1504:
1487:
1412:Valve repair
1402:Heart valves
1317:
1308:
1272:
1268:
1262:
1229:
1225:
1219:
1195:(1): 47–52.
1192:
1188:
1178:
1153:
1150:Heart Rhythm
1149:
1142:
1117:
1111:
1105:
1091:cite journal
1067:(3): 332–8.
1064:
1060:
1050:
1017:
1013:
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980:
976:
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933:
929:
923:
899:(3): 803–9.
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814:
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657:
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574:(1): 56–64.
571:
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437:heart valves
421:
392:
354:
353:
295:
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256:
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218:epicardially
217:
200:
189:
180:
169:
140:
131:epicardially
130:
128:
120:
80:
52:
50:
2030:Cardiac PET
1773:Pericardium
1737:Atherectomy
1675:Angioplasty
1417:Valvulotomy
1275:(1): 34–8.
977:Circulation
936:(1): 51–4.
855:Eur Heart J
265:pericardium
234:cryosurgery
135:endocardial
98:endocardial
2122:Categories
2025:Cardiac CT
1892:Cardiotomy
1797:Myocardium
1565:Sano shunt
1355:procedures
1353:Tests and
475:References
367:ultrasonic
314:, and the
230:ultrasonic
173:endoscopic
137:approach:
1405:and septa
431:, marked
328:autonomic
320:autonomic
300:endoscope
281:microwave
269:microwave
261:endoscope
226:microwave
220:by using
208:endoscope
175:surgical
2109:Category
1842:minimaze
1838:Cox maze
1289:18154774
1254:13944757
1246:17919294
1211:14715182
1170:17556213
1134:22078990
1083:21632865
1042:19856445
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340:ablation
322:nerves (
273:ablation
177:ablation
28:ICD-9-CM
1394:Surgery
871:8070496
589:5834122
509:2008095
2081:Pacing
1689:MIDCAB
1680:Bypass
1630:shunt
1524:atrium
1437:mitral
1432:aortic
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371:atrium
332:atrium
316:atrial
308:atrium
304:atrium
277:atrial
263:. The
245:stroke
241:atrium
164:mitral
155:atrial
151:atrial
124:atrial
2038:sound
1910:Tests
1868:S-ICD
1765:Other
1699:TECAB
1544:aorta
1359:heart
1250:S2CID
1038:S2CID
954:S2CID
429:atria
228:, or
94:atria
40:[
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1840:and
1578:for
1285:PMID
1242:PMID
1207:PMID
1166:PMID
1130:PMID
1097:link
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338:for
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1982:TTE
1874:ICD
1669:CHD
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