Pulmonary vein isolation for chronic atrial fibrillation associated with mitral valve disease: the midterm results.
OBJECTIVE
The Cox Maze procedure is widely performed for the surgical treatment of atrial fibrillation. However it requires numerous incision lines and therefore is a time-consuming operation. We report a simplified operation for chronic atrial fibrillation associated with mitral valve disease.


METHODS
Pulmonary vein isolation procedure was performed on atrial fibrillation associated with mitral valve disease in thirteen patients. This simple procedure consisted of isolation of the four pulmonary veins only. Combined mitral valve surgery involved mitral valve plasty, mitral valve replacement with or without aortic valve replacement and tricuspid annuloplasty.


RESULTS
Eleven patients returned to sinus rhythm (84.6%). Mean follow-up time is 32.7 +/- 11.7 months. Three patients required a DDD pacemaker implant for sick sinus syndrome but two out of these three resumed sinus rhythm most of the time recently. Left atrial contraction was detected in eight cases by trans-esophageal echo. One patient died of liver failure two months postoperatively. Eight patients had no blood transfusion. Twelve patients are classified as New York Heart Association class I.


CONCLUSIONS
Compared with the Maze procedure, this operation was less invasive and preserved the atrial appendage and was thought to have a normal level of secretion of atrial natriuretic peptide. This study suggests that the pulmonary vein isolation procedure may be an effective and simple maneuver for atrial fibrillation associated with mitral valvular disease.
Tanaka
Hiroyuki
H
Department of Thoracic Cardiovascular Surgery, Showa University Fujigaoka Hospital, Aoba-ku, Yokohama, Japan.
Narisawa
Takashi
T
Mori
Takanobu
T
Masuda
Mikio
M
Suzuki
Takashi
T
Takaba
Toshihiro
T
D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications* / Q000601:surgery / Q000628:therapy*; D002315:Cardiopulmonary Bypass; D002908:Chronic Disease; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D006324:Heart Arrest, Induced; D006329:Heart Conduction System / Q000503:physiopathology; D006349:Heart Valve Diseases / Q000150:complications* / Q000601:surgery / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D010138:Pacemaker, Artificial; D011667:Pulmonary Veins / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome