Figure 1.

Preoperative and postoperative electrocardiography. (A,B) Preoperative and postoperative 12-lead surface electrocardiogram in a 71-year-old female with long standing persistent atrial fibrillation and severe LVOT obstruction with severe pulmonary hypertension undergoing the combined operation. An extended septal myectomy, Cox-Maze IV and tricuspid annuloplasty were performed. See the fibrillatory atrial waves in the preoperative ECG (upper left). On postoperative 6-month follow up sinus rhythm can be appreciated as well as the complete left bundle branch block after septal myectomy (upper right). (C,D) Preoperative and postoperative electrocardiogram of a 68-y-o female patient with long standing persistent atrial fibrillation, severe LVOT obstruction and moderate aortic valve stenosis undergoing transaortic septal myectomy, Cox-Maze IV and tissue aortic valve replacement. Marked fibrillatory atrial waveforms can again be appreciated preoperatively (C). In this case, restoration of sinus rhythm can be appreciated but left bundle branch block did not occur (D). LVOT, left ventricular outflow tract.