Atrial Fibrillation Treatment Innovations
Dr. John H. Sirak has been a leader in advancing the surgical treatment of atrial fibrillation within the framework of the five-box thoracoscopic maze surgery approach. He was the first surgeon to publish in a peer-reviewed journal a comprehensive, five-box thoracoscopic operation designed to treat the left atrium directly. In addition, he was the first to develop the connecting ablations between the annulus of the mitral valve and the left atrial roof line in a five-box thoracoscopic procedure. These intersecting lines are critically important in curing patients with advanced atrial fibrillation.
Dr. Sirak was also the first advocate for connecting the left atrial floor line between the inferior pulmonary veins. The purpose for this previously overlooked line was to enable independent testing of the integrity of the "third box." This electrically isolated compartment within the posterior left atrium comprises the two pulmonary antrums, the left atrial roof line superiorly, and the left atrial floor line inferiorly. With the advent of the "third box," the important left atrial roof line ablations could be verified independently.
Probably the most important innovation contributed by Ohio heart surgeon Dr. Sirak is the development of the "fourth box." As described in subsequent text and illustrations, the fourth box is a triangle on the dome of the left atrium bounded by the transmitral line connecting the mitral annulus to the left atrial roof line, by the roof line itself, and by a line from the right superior pulmonary junction with the left atrium to the apex of the transmitral line. This development enabled independent verification of the important transmitral line using the highest standard of bidirectional block. The innovation lay in mobilizing key anatomy, thereby providing enough area within this compact space to demonstrate bidirectional block.
These contributions are a testament to Dr. Sirak's commitment not only to delivering the complete set of lesions necessary to treat advanced atrial fibrillation, but also to upholding the principle of comprehensive real-time verification of every component of the operation.
For more details about five-box thoracoscopic maze surgery for atrial fibrillation treatment, or to find out if you may be a candidate, request a phone consultation with Dr. Sirak, a Columbus, Ohio cardiothoracic surgeon. Dr. Sirak also can be reached at his appointment phone: (614) 366-7414.