Impact of left atrial size reduction on chronic atrial fibrillation in mitral valve surgery.
OBJECTIVE
Left atrial enlargement is a risk factor for the development of atrial fibrillation (AF). Large atrial size increases thromboembolic risk and reduces the success rate of cardioversion. The study aim was to evaluate if left atrial size reduction affects cardiac rhythm in patients with chronic AF undergoing mitral valve surgery.


METHODS
Twenty-seven patients were analyzed prospectively. The left atrial incision was extended to the left inferior pulmonary vein. Left atrial size reduction was achieved by closure of the left atrial appendage from inside with a double running suture. The same suture plicated the left lateral atrial wall to the roof of the left pulmonary vein inflow and the inferior atrial wall. The atrial septum was plicated by placing stitches of the closing suture line across the fossa ovalis. Rhythm, neurological complications, cardioversion, anticoagulation and anti-arrhythmic medication were evaluated at one year postoperatively and at recent follow up (mean 40 +/- 15 months).


RESULTS
At discharge, five patients (19%) were in sinus rhythm (SR). At one year postoperatively, SR was restored in 17 patients (63%), but five (19%) reported episodes of arrhythmia and AF persisted in 10 (37%). At recent follow up, four patients had died and three were lost to follow up. Among 20 patients examined, 13 (65%) had SR but six reported episodes of arrhythmia and AF persisted in seven (35%). LA diameter was significantly reduced, from 60.2 +/- 9.8 mm preoperatively to 44.5 +/- 7.0 mm at one year after surgery.


CONCLUSIONS
The addition of left atrial size reduction to mitral valve surgery is technically simple, and was effective in 63% of patients with chronic AF, restoring predominant SR. In order to influence pathogenetic factors other than size, additional ablative steps may further increase the SR conversion rate. Size reduction may also improve the outcome of other ablative approaches.
Scherer
Mirela
M
Department of Thoracic and Cardiovascular Surgery, J. W. Goethe University, Frankfurt am Main, Germany.
Dzemali
Omer
O
Aybek
Tayfun
T
Wimmer-Greinecker
Gerhard
G
Moritz
Anton
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000638:Amiodarone / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation; D002304:Cardiac Pacing, Artificial; D002315:Cardiopulmonary Bypass; D002908:Chronic Disease; D015331:Cohort Studies; D004074:Digitoxin / Q000627:therapeutic use; D004452:Echocardiography; D004554:Electric Countershock; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000473:pathology* / Q000601:surgery*; D006329:Heart Conduction System / Q000187:drug effects / Q000473:pathology; D006349:Heart Valve Diseases / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000628:therapy; D013015:Sotalol / Q000627:therapeutic use; D016019:Survival Analysis; D016896:Treatment Outcome; D014700:Verapamil / Q000627:therapeutic use
D000889:Anti-Arrhythmia Agents; D013015:Sotalol; D014700:Verapamil; D004074:Digitoxin; D000638:Amiodarone