[Left atrial electric isolation in the treatment of atrial fibrillation secondary to rheumatic valvular disease].
BACKGROUND
Surgical isolation of the left atrium was performed for the treatment of chronic atrial fibrillation secondary to valvular disease in 100 patients who underwent valve surgery.


METHODS
From May 1989 to September 1991, 62 patients underwent mitral valve surgery (Group I), 19 underwent mitral valve surgery and DeVega tricuspid annuloplasty (Group II), 15 underwent mitral and aortic surgery (Group III), and 4 patients underwent mitral and aortic surgery and DeVega tricuspid annuloplasty (Group IV). Left atrial isolation was performed prolonging the usual left paraseptal atriotomy towards the left fibrous trigone anteriorly, and the postero-medial commissure posteriorly. The incision was conducted a few millimeters apart from the mitral valve annulus, and cryolesion were placed at the edges to ensure complete electrophysiological isolation of the left atrium.


RESULTS
Operative mortality accounted for 3 cases (3%). In 79 patients (81.4%) sinus rhythm recovered and persisted until discharge from the hospital. No differences were found between the groups (Group I: 80.7%; Group II: 68.5%; Group III 86.7%, Group IV 75% - p = N.S.). Three cases of late mortality (3.1%) were registered. long-term results showed persistence of SR in 71% of Group I, 61.2% of Group II, 85.8% of Group III, and 100% of Group IV. The unique risk factor for late recurrency of atrial fibrillation was found to be a duration of preoperative AF longer than 6 months.


CONCLUSIONS
Due to the high success rate in recovering the sinus rhythm, we suggest left atrial isolation in patients with chronic atrial fibrillation undergoing valvular surgery.
Graffigna
A
A
Cattedra dai Cardiochirurgia, Università degli studi di Pavia, I.R.C.C.S. Policlinico S. Matteo.
Pagani
F
F
Minzioni
G
G
Salerno
J
J
Viganò
M
M
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000209:etiology / Q000601:surgery*; D004562:Electrocardiography; D005260:Female; D006325:Heart Atria / Q000601:surgery*; D006349:Heart Valve Diseases / Q000150:complications*; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000601:surgery; D008946:Mitral Valve Stenosis / Q000150:complications / Q000601:surgery; D012008:Recurrence; D012214:Rheumatic Heart Disease / Q000150:complications*; D012307:Risk Factors; D013997:Time Factors
L'isolamento elettrico dell'atrio sinistro per il trattamento della fibrillazione atriale secondaria a valvulopatia reumatica.