Seven-Year Experience with Ablation of Permanent Atrial Fibrillation Concomitant to Mitral Valve Surgery in 152 Patients

  • Stephan Geidel
  • Michael Lass
  • Jörg Ostermeyer

Abstract

Background. This study analyzed 7 years of results for monopolar endocardial radiofrequency (RF) ablation of permanent atrial fibrillation (pAF) concomitant to mitral valve (MV) surgery.

Methods. Between 2001 and 2007, 152 patients who had experienced pAF for a median of 4.0 years (interquartile range, 1.5-8.0 years; range, 0.5-33 years) underwent monopolar endocardial RF ablation procedures (pulmonary vein isolation plus a connecting lesion) concomitant to MV surgery. All patients were reexamined to assess survival, conversion rate to stable sinus rhythm (SR), and New York Heart Association (NYHA) class at 8 ± 1 days after surgery and follow-ups at 3 ± 1 months and 41 ± 24 months postoperatively. Data were analyzed exploratatively.

Results. The survival rates at the 3 reexamination times were 97%, 95%, and 92%, respectively (6 cardiac and 6 noncardiac deaths), and the corresponding SR rates were 74%, 75%, and 73%. The NYHA class of the patients improved significantly after surgery (P = .006), particularly when a stable SR had been achieved (P = .039). Long-term pAF prior to surgery and a larger left atrium (LA) preoperatively were predictive of the return of postoperative AF (P = .0002, and P = .0003, respectively). Ninety-one percent of the patients with a preoperative pAF duration of <5 years and 88% of the patients with an LA size of ?55 mm were in stable SR at the late follow-up. The cardiac rhythm at discharge and 3 months after surgery were predictive of a prognosis of long-term rhythm (P = .021, and P = .00002, respectively). Age, sex, and the underlying etiology of MV disease did not have a significant influence on postoperative cardiac rhythm.

Conclusion. This study demonstrated that a SR established after combined pAF ablation and MV surgery remains stable over time. Preoperative LA size and pAF duration are useful parameters for evaluating the success rate of pAF ablation concomitant to MV surgery.

References

Bakir I, Casselmann FP, Brugada P, et al. 2007. Current strategies in the surgical treatment of atrial fibrillation: review of the literature and Onze Lieve Vrouw Clinic's strategy. Ann Thorac Surg 83:331-40.\nBenjamin EJ, Wolf PA, D'Agostino RB, Silbershatz H, Kannel WB, Levy D. 1998. Impact of atrial fibrillation on the risk of death: the Framingham Heart Study. Circulation 98:946-52.\nBenussi S, Pappone C, Nascimbene S, et al. 2000. A simple way to treat chronic atrial fibrillation during mitral valve surgery: the epicardial radiofrequency approach. Eur J Cardiothorac Surg 17:524-9.\nCarpentier A. 1983. Cardiac valve surgery: the "French correction." J Thorac Cardiovasc Surg 86:323-37.\nCox JL, Schuessler RB, Lappas DG, Boineau JP. 1996. An 8 1/2-year clinical experience with surgery for atrial fibrillation. Ann Surg 224:267-75.\nGeidel S, Laß M, Boczor S, Kuck KH, Ostermeyer J. 2004. Monopolar and bipolar radiofrequency ablation surgery: 3-year experience in 90 patients with permanent atrial fibrillation. Heart Surg Forum 7:E398-402.\nGillinov AM, Pettersson G, Rice TW. 2001. Esophageal injury during radiofrequency ablation for atrial fibrillation. J Thorac Cardiovasc Surg 122:1239-40.\nGoette A Staack T, Röcken C, et al. 2000. Increased expression of extracellular signal-regulated kinase and angiotensin-converting enzyme in human atria during atrial fibrillation. J Am Coll Cardiol 35:1669-77.\nHaissaguerre M, Jais P, Shah DC, et al. 1998. Spontaneous initiation of atrial fibrillation by ectopic beats originating from the pulmonary veins. N Engl J Med 339:659-66.\nJahangiri M, Weir G, Mandal K, Savelieva I, Camm J. 2006. Current strategies in the management of atrial fibrillation. Ann Thorac Surg 82:357-64.\nJansz P, Bennetts J, Wilson M, Spratt P, Farnsworth A. 2003. Restoration of sinus rhythm following mitral valve surgery with left atrial reduction in patients with chronic atrial fibrillation [abstract]. Annual Scientific Meeting of the Society of Cardiothoracic Surgeons of Great Britain and Ireland, 2003. Abstract 38.\nJessurun UR, van Hemel NM, Kelder JC, et al. 2000. Mitral valve surgery and atrial fibrillation: is atrial fibrillation surgery also needed? Eur J Cardiothorac Surg 17:530-7.\nKawara T, Derksen R, de Groot JR, et al. 2001. Activation delay after premature stimulation in chronically diseased human myocardium relates to the architecture of interstitial fibrosis. Circulation 104:3069-75.\nKhargi K, Kuschkowitz F, Deneke T, et al. 2003. Cooled-tip-radiofrequency ablation is a distinct different technique to treat chronic atrial fibrillation: a prospective study including 138 patients [abstract]. Thorac Cardiovasc Surg 51(suppl 1):S52.\nKnaut M, Tugtekin SM, Gulielmos V. 2003. Microwave ablation as an additional procedure for treatment of permanent atrial fibrillation in patients with cardiosurgical disease [abstract]. Thorac Cardiovasc Surg 51(suppl 1):S51.\nLi D, Fareh S, Leung TK, Nattel S. 1999. Promotion of atrial fibrillation by heart failure in dogs: atrial remodeling of a different sort. Circulation 100:87-95.\nMelo J, Andragao P, Neves J, et al. 2000. Endocardial and epicardial radiofrequency ablation in the treatment of atrial fibrillation with a new intraoperative device. Eur J Cardiothorac Surg 18:182-6.\nWijffels MCEF, Kirchhof CJHJ, Dorland R, Allessie MA. 1995. Atrial fibrillation begets atrial fibrillation: a study in awake chronically instrumented goats. Circulation 92:1954-68.\nMelo J, Berglin E, Sie H, et al. 2006. Surgery for atrial fibrillation in mitral patients with and without additional procedures: results at 5 years from an international registry. Paper presented at the 86th AATS Annual Meeting; 2006 April 29-May 3; Philadelphia, Pa, USA.\nMoe GK. 1962. On the multiple wavelet hypothesis of atrial fibrillation. Arch Int Pharmacodyn Ther 140:183-8.\nRoy D, Talajic M, Dorian P, et al. 2000. Amiodarone to prevent recurrence of atrial fibrillation. N Engl J Med 342:913-20.\nSueda T, Nagata H, Oriashi K, et al. 1997. Efficacy of a simple left atrial procedure for chronic atrial fibrillation in mitral valve operations. Ann Thorac Surg 63:1070-5.\nAllessie M, Lammers WJEP, Bunke FI, Hollen J. 1985. Experimental evaluation of Moe's multiple wavelet hypothesis of atrial fibrillation. In: Zipes D, Jalife J, eds. Cardiac electrophysiology and arrhythmias. New York, NY: Cruno and Straiton: 265-75.\n
Published
2008-06-26
How to Cite
Geidel, S., Lass, M., & Ostermeyer, J. (2008). Seven-Year Experience with Ablation of Permanent Atrial Fibrillation Concomitant to Mitral Valve Surgery in 152 Patients. The Heart Surgery Forum, 11(3), E175-E180. https://doi.org/10.1532/HSF98.20081027
Section
Articles