Modulation of atrial fibrillation

In this thesis we investigate the results of various surgical procedures for atrial fibrillation which have been performed in the last 2 decades in the Sint Antonius Hospital, Nieuwegein, The Netherlands. In the 1990s the classical Maze III procedure was the main surgical technique for drug-refractory symptomatic lone atrial fibrillation at the Sint Antonius Hospital. A better understanding of the pathophysiology of atrial fibrillation has enabled an evolution in the surgical treatment of atrial fibrillation. Nowadays a completely thoracoscopic procedure is the main surgical therapy for lone atrial fibrillation at the Sint Antonius Hospital. Because knowledge and therapy of atrial fibrillation go hand in hand, this thesis deals also with the structural and humoral remodeling associated with atrial fibrillation, in particular with the amount of atrial fibrosis in patients with and without atrial fibrillation and with the electrophysiological effects of different neurotransmitters. This may help in developing more effective and probably tailored, patient specific and mechanism (substrate/trigger) specific, therapeutic procedures for atrial fibrillation.