Long-term Outcomes of Surgical Radiofrequency Ablation for Atrial Fibrillation in 3 Groups of Patients
Background. Left atrial surgical radiofrequency ablation represents an applicable and technically less demanding method for treating paroxysmal or permanent atrial fibrillation (AF) as a concomitant procedure. The aim of this study was to review the long-term outcomes of radiofrequency linear ablation for the treatment of AF limited to the left atrium in 3 groups of patients undergoing cardiac surgery.
Methods. The study population consisted of 357 consecutive patients, who were divided into 3 groups on the basis of the underlying disease: group I, 126 patients with nonischemic mitral valve disease; group II, 164 patients with coronary artery disease and aortic and/or ischemic mitral valve disease or who underwent other concomitant procedures; and group III, 67 patients with coronary artery disease only.
Results. Follow-up times were between 6 and 48 months (mean, 28.3 + 9.4 months). The 30-day hospital mortality rate was 2.80% (10 patients). Total mortality during the follow-up period reached 4.48% (16 patients). At discharge, 66% of group I patients, 64% of group II patients, and 69% of group in patients were in sinus rhythm. After 24 months, 60% of group I patients, 75% of group II patients, and 67% of group III patients were in sinus rhythm. A subgroup analysis of the patients with permanent AF showed that only 54% of these patients in group I, 52% in group II, and 67% in group III had a restored sinus rhythm at 24 months. Subgroup analysis also revealed that only 6 (27%) of 22 patients with a left atrium diameter >60 mm maintained a sinus rhythm during long-term follow-up. Biatrial contraction was restored in 75% of the patients with a stable sinus rhythm after 6 months of follow-up. Seven patients (2%) with symptomatic postoperative recurrent atrial arrhythmias underwent subsequent catheter ablation.
Conclusion. Left atrial surgical radiofrequency ablation represents an applicable and technically less demanding method for treating paroxysmal or permanent AF as a concomitant procedure. Our results demonstrate the feasibility of this procedure for paroxysmal and persistent AF, with minimal risks to the patient. For permanent AF, further investigation and extensive intervention are essential.
Abadie J, Faure A, Chaillet N, et al. 2006. A new minimally invasive heart surgery instrument for atrial fibrillation treatment: first in vitro and animal tests. Int J Med Robot 2:188-96.nAlbirini A, Scalia GM, Murray RD, et al. 1997. Left and right atrial transport function after the Maze procedure for atrial fibrillation: an echocardio-graphic Doppler follow-up study. J Am Soc Echocardiogr 10:937-45.nBadhwar V, Rovin JD, Davenport G, et al. 2006. Left atrial reduction enhances outcomes of modified maze procedure for permanent atrial fibrillation during concomitant mitral surgery. Ann Thorac Surg 82:1758-63.nFayad G, Le Tourneau T, Modine T, et al. 2005. Endocardial radiofrequency ablation during mitral valve surgery: effect on cardiac rhythm, atrial size, and function. Ann Thorac Surg 79:1505-11.nFuster V, Ryden LE, Cannom DS, et al. 2006. ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: full text: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients with Atrial Fibrillation) developed in collaboration with the European Heart Rhythm Association and the Heart Rhythm Society. Europace 8:651-745.nGehi AK, Adams DH, Salzberg SP, Filsoufi F. 2006. Outcomes and predictors of success of a radiofrequency- or cryothermy-simplified leftsided maze procedure in patients undergoing mitral valve surgery. J Heart Valve Dis 15:360-7.nGrubitzsch H, Beholz S, Dohmen PM, Dushe S, Liu J, Konertz W. 2007. Ablation of atrial fibrillation in valvular heart surgery: are results determined by underlying valve disease? J Heart Valve Dis 16:76-83.nHaissaguerre M, Jais P, Shah DC, et al. 1998. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 339:659-66.nHalkos ME, Craver JM, Thourani VH, et al. 2005. Intraoperative radiofrequency ablation for the treatment of atrial fibrillation during concomitant cardiac surgery. Ann Thorac Surg 80:210-5.nJeanmart H, Casselman F, Beelen R, et al. 2006. Modified maze during endoscopic mitral valve surgery: the OLV Clinic experience. Ann Thorac Surg 82:1765-9.nKawaguchi AT, Kosakai Y, Isobe F, et al. 1996. Factors affecting rhythm after the maze procedure for atrial fibrillation. Circulation 94:II139-42.nKhargi K, Hutten BA, Lemke B, Deneke T. 2005. Surgical treatment of atrial fibrillation: a systematic review. Eur J Cardiothorac Surg 27:258-65.nKobza R, Hindricks G, Tanner H, et al. 2004. Late recurrent arrhythmias after ablation of atrial fibrillation: incidence, mechanisms, and treatment. Heart Rhythm 1:676-83.nMarui A, Nishina T, Tambara K, et al. 2006. A novel atrial volume reduction technique to enhance the Cox maze procedure: initial results. J Thorac Cardiovasc Surg 132:1047-53.nMarui A, Tambara K, Tadamura E, et al. 2007. A novel approach to restore atrial function after the maze procedure in patients with an enlarged left atrium. Eur J Cardiothorac Surg 32:308-12.nMelby SJ, Zierer A, Bailey MS, et al. 2006. A new era in the surgical treatment of atrial fibrillation: the impact of ablation technology and lesion set on procedural efficacy. Ann Surg 244:583-92.nMelo JQ, Santiago T, Gouveia RH, Martins AP. 2004. Atrial ablation for the surgical treatment of atrial fibrillation: principles and limitations. J Card Surg 19:207-10.nNilsson B, Chen X, Pehrson S, Kober L, Hilden J, Svendsen JH. 2006. Recurrence of pulmonary vein conduction and atrial fibrillation after pulmonary vein isolation for atrial fibrillation: a randomized trial of the ostial versus the extraostial ablation strategy. Am Heart J 152:537.e1-8.nSie HT, Beukema WP, Elvan A, Ramdat Misier AR. 2004. Long-term results of irrigated radiofrequency modified maze procedure in 200 patients with concomitant cardiac surgery: six years experience. Ann Thorac Surg 77:512-6.nSueda T, Imai K. 2005. Surgical ablation of atrial fibrillation. Ann Thorac Cardiovasc Surg 11:285-7.nTopkara VK, Williams MR, Cheema FH, et al. 2006. Surgical ablation of atrial fibrillation: the Columbia Presbyterian experience. J Card Surg 21:441-8.nVojácek J, Hlubocky J, Burkert J, Telekes P, Spatenka J, Pavel P. 2005. Ischemic mitral regurgitation: clinical review emphasizing the surgical treatment. Cas Lek Cesk 144:233-7.nYashima N, Nasu M, Kawazoe K, Hiramori K. 1997. Serial evaluation of atrial function by Doppler echocardiography after the maze procedure for chronic atrial fibrillation. Eur Heart J 18:496-502.nYuda S, Nakatani S, Kosakai Y, Yamagishi M, Miyatake K. 2001. Long-term follow-up of atrial contraction after the maze procedure in patients with mitral valve disease. J Am Coll Cardiol 37:1622-7.nZimetbaum P. 2006. Restoring normal sinus rhythm in atrial fibrillation: evidence from pharmacologic therapy and catheter abaltion trials. Curr Cardiol Rep 8:377-86.n
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