eComment. Spontaneous conversion from atrial fibrillation to typical atrial flutter during the operation

We have read the orginal article of Geuzebroek et al., entitled Totally thoracoscopic left atrial Maze: standardized, effective and safe with great interest [1]. The authors have reported that the totally thoracoscopic left atrial Maze is a relatively new surgical solution for the treatment of atrial fibrillation (AF). The procedure consists of a complete left atrial Maze, which is performed by video-assisted thoracoscopy with the use of radiofrequency ablation. They describe their rhythm results as well as our learning curve experience of the (totally thoracoscopic left atrial Maze) TT-Maze. They have concluded that even after one year follow-up period, the TT-Maze has proved to be a successful, safe, and also a reproducible strategy for the treatment of all types of AF including patients with enlarged left atrium and previous failure of catheter ablation.

However, we think that there are some issues to be clarified in this study. Previously, we experienced that spontaneous conversion of AF to typical atrial flutter was observed after elimination of the arrhythmogenic pulmonary vein during ablation in some cases. Afterwards, we have done cavotricuspid isthmus line ablation in same procedure. Finally, restoration of sinus rhythm has been achieved. First question: did the authors encounter any case of AF who converted to typical atrial flutter during the AF ablation? Second question: could they perform cavotricuspid isthmus line ablation if they observed, and how? We hope that this study will pioneer the investigations to seek and develop novel ablation treatment strategies for AF. Since the population with AF is growing enormously due to aging and also improvement of survival from cardiovascular disease.

Conflict of interest: none declared.