Excision of the LAA
As previously described2, 7, the patient underwent general anesthesia with a double lumen endotracheal tube for selective single-lung ventilation, and then was placed in the supine position with bilateral forearms alongside the body and slightly below the table to expose the axillary regions. After right single-lung ventilation, the procedure was begun on the left side in the fourth intercostal space on the midaxillary line. The left-side pericardium was opened at 2 cm posterior to the phrenic nerve to expose LAA. Then activation mapping and ablation was performed on the epicardial surface of LAA.
After ablation, the LAA atriotomy is closed between two 4–5 mm wide strips of Teflon felt to reinforce the fragile tissue, using a mattress suture followed by a continuous over and over sutures to definitely close the resection line. Then the LAA was excised at the orifice leaving a remnant of 5 mm under gentle traction of both sutures2.