Sinus node function after mitral valve surgery using the superior septal approach.
BACKGROUND; Sinus node function after the superior septal approach (SSA) in mitral valve surgery is controversial. We assessed sinus node function after this approach based on electrophysiological examinations and electrocardiographic change.


METHODS
Forty-six patients underwent successful mitral valve surgery via the SSA. Preoperatively, 25 patients were in atrial fibrillation (AF), 20 were in normal sinus rhythm (SR), and 1 patient was paced. Thirteen patients who demonstrated no sinus node dysfunction preoperatively underwent postoperative electrophysiological studies. Peripostoperative cardiac rhythm was monitored using a portable four-lead electrocardiograph, and late cardiac rhythm was examined using standard 12-lead electrocardiography in the outpatient clinic.


RESULTS
Twelve of 20 patients with preoperative SR experienced early postoperative supraventricular arrhythmias, but all spontaneously recovered SR. Electrophysiological studies revealed a basic cycle length of 767 +/- 74 ms, sinoatrial conduction time of 72 +/- 34 ms, sinus node recovery time of 1,119 +/- 139 ms, and corrected sinus node recovery time of 349 +/- 114 ms, thus demonstrating a lack of sinus node dysfunction. During the postoperative period (34 +/- 24 months), 2 of the 20 patients with preoperative SR developed persistent AF, and 3 of the 25 patients with preoperative AF achieved normal SR.


CONCLUSIONS
The SSA does not appear to cause longterm adverse effects on sinus node function, although temporary effects may occur.
Division of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan. h-shin@med.keio.ac.jp
H
H
Shin
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R
Yozu
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S
Higashi
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S
Kawada
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000503:physiopathology / Q000601:surgery*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006346:Heart Septum / Q000503:physiopathology / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000503:physiopathology*; D012849:Sinoatrial Node / Q000503:physiopathology*; D013617:Tachycardia, Supraventricular / Q000503:physiopathology; D016896:Treatment Outcome