\documentclass[10pt]{article}

\usepackage{fullpage}
\usepackage{setspace}
\usepackage{parskip}
\usepackage{titlesec}
\usepackage[section]{placeins}
\usepackage{xcolor}
\usepackage{breakcites}
\usepackage{lineno}
\usepackage{hyphenat}





\PassOptionsToPackage{hyphens}{url}
\usepackage[colorlinks = true,
            linkcolor = blue,
            urlcolor  = blue,
            citecolor = blue,
            anchorcolor = blue]{hyperref}
\usepackage{etoolbox}
\makeatletter
\patchcmd\@combinedblfloats{\box\@outputbox}{\unvbox\@outputbox}{}{%
  \errmessage{\noexpand\@combinedblfloats could not be patched}%
}%
\makeatother


\usepackage{natbib}




\renewenvironment{abstract}
  {{\bfseries\noindent{\abstractname}\par\nobreak}\footnotesize}
  {\bigskip}

\titlespacing{\section}{0pt}{*3}{*1}
\titlespacing{\subsection}{0pt}{*2}{*0.5}
\titlespacing{\subsubsection}{0pt}{*1.5}{0pt}


\usepackage{authblk}


\usepackage{graphicx}
\usepackage[space]{grffile}
\usepackage{latexsym}
\usepackage{textcomp}
\usepackage{longtable}
\usepackage{tabulary}
\usepackage{booktabs,array,multirow}
\usepackage{amsfonts,amsmath,amssymb}
\providecommand\citet{\cite}
\providecommand\citep{\cite}
\providecommand\citealt{\cite}
% You can conditionalize code for latexml or normal latex using this.
\newif\iflatexml\latexmlfalse
\providecommand{\tightlist}{\setlength{\itemsep}{0pt}\setlength{\parskip}{0pt}}%

\AtBeginDocument{\DeclareGraphicsExtensions{.pdf,.PDF,.eps,.EPS,.png,.PNG,.tif,.TIF,.jpg,.JPG,.jpeg,.JPEG}}

\usepackage[utf8]{inputenc}
\usepackage[english]{babel}



\usepackage{float}








\begin{document}

\title{HYBRID TOTALLY THORACOSCOPIC MAZE AND CATHETER ABLATION FOR LONG
STANDING PERSISTENT ATRIAL FIBRILLATION: INITIAL EXPERIENCE}



\author[1]{Adrian Pick}%
\author[1]{Andrew Kroger}%
\author[1]{Emily Kotschet}%
\author[1]{Stuart Healy}%
\author[1]{David Adam}%
\author[1]{Logan Bittinger}%
\author[1]{Imran Khan}%
\author[1]{Julian Smith}%
\affil[1]{Monash University}%


\vspace{-1em}



  
  \date{May 07, 2024}


\begingroup
\let\center\flushleft
\let\endcenter\endflushleft
\maketitle
\endgroup





\selectlanguage{english}
\begin{abstract}
Atrial Fibrillation is now a pandemic in our ageing community. Although
Cox (1987) devised a surgical procedure with near-universal curative
success, widespread clinical endorsement has not followed. Meanwhile,
catheter-based interventions have flourished. For persistent Atrial
Fibrillation (AF), however, an isolated endocardial approach has
significant limitations: procedural times are long, carry risk, and the
outcomes are poor. By combining left atrial endocardial and epicardial
interventions with staged mapping, we optimise the benefits of both
approaches. We report our first twenty-five consecutive patients
undergoing Totally-Thoracoscopic-Maze procedure (TT), followed at three
months by staged electrophysiologic (EP) mapping. Selected patients had
symptomatic, lone atrial fibrillation, of greater than twelve months
duration, having failed to revert despite multiple antiarrhythmic
agents. Patients were excluded if they had received prior EP
intervention or required additional procedures for coronary
revascularisation, valvular heart disease, or thoracic surgery. The
average patient age was 60 years (78\% male). The main symptoms observed
were palpitations (53\%), fatigue (59\%), chest pain (20\%) and
dizziness (23\%). A history of transient ischemic attack was recorded in
only one patient. There were no major in-hospital complications; death,
stroke, left atrio-oesophageal fistula or conversions to sternotomy.
Perioperative atrial-fibrillation was observed in only three patients
and, with the institution of antiarrhythmics, all patients achieved
sinus-rhythm. 14/25 patients progressed to staged EP mapping for an
overall sinus conversion rate of 100\%. Our initial series of hybrid
ablation for long-standing, persistent atrial fibrillation reports
excellent early outcomes, freedom from complications and universal
success.%
\end{abstract}%



\sloppy


\textbf{Hosted file}

\verb`TTMAZE EDIT 6 j of cardiac surgery FINAL.docx`  available at \url{https://authorea.com/users/346900/articles/472708-hybrid-totally-thoracoscopic-maze-and-catheter-ablation-for-long-standing-persistent-atrial-fibrillation-initial-experience}

\selectlanguage{english}
\FloatBarrier
\end{document}

