title: Atrial arrhythmia following a biatrial approach to mitral valve surgery.
abstract: The biatrial approach to exposing the mitral valve during surgery has the potential for improving visualization of the valve with minimal cardiac manipulation. This procedure, involving a right atriotomy and an extended transseptal incision, may isolate the sinus node from its normal blood supply and autonomic innervation. Thirty-eight consecutive patients undergoing this procedure were examined. Twenty-two of these patients (58%) were admitted in normal sinus rhythm and 15 (40%) were in atrial fibrillation (AF) or atrial flutter. Of the 22 patients admitted in normal sinus rhythm, only 3 patients remained in this rhythm at discharge. Fourteen of the 22 patients were discharged in a slow, low atrial rhythm. All of the patients admitted in AF were discharged in AF. Of the 14 patients discharged in a low atrial rhythm, the rhythm persisted in eleven patients (80%) at a mean of 6-month follow-up. The routine use of this transseptal approach to mitral valve surgery needs further assessment in light of the predictable loss of the sinus mechanism.
authors.affiliation: Department of Cardiac Electrophysiology, New York University Medical Center, New York 10016, USA.
authors.forename: N E
authors.initials: NE
authors.lastname: Bernstein
authors.forename: N T
authors.initials: NT
authors.lastname: Skipitaris
authors.forename: T V
authors.initials: TV
authors.lastname: Glotzer
authors.forename: J
authors.initials: J
authors.lastname: Delianides
authors.forename: L A
authors.initials: LA
authors.lastname: Chinitz
authors.forename: S
authors.initials: S
authors.lastname: Colvin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001145:Arrhythmias, Cardiac / Q000209:etiology*; D001281:Atrial Fibrillation / Q000601:surgery; D001282:Atrial Flutter / Q000601:surgery; D001341:Autonomic Nervous System / Q000601:surgery; D003331:Coronary Vessels / Q000601:surgery; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000601:surgery; D006339:Heart Rate; D006346:Heart Septum / Q000601:surgery; D006801:Humans; D008297:Male; D008722:Methods; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D012849:Sinoatrial Node / Q000294:innervation / Q000601:surgery