Isolation of the pulmonary veins in patients with permanent atrial fibrillation secondary to mitral valve disease.
OBJECTIVE
To assess the efficacy of surgical isolation of the pulmonary veins for re-establishing sinus rhythm in patients with atrial fibrillation secondary to mitral valve disease.


METHODS
Thirty-three (67% were women) patients with permanent atrial fibrillation and indication for surgical correction of the mitral valve underwent surgical isolation of the pulmonary veins. Their mean age was 56.3+/-10 years, preoperative NYHA functional class was 3.2+/-0.6, left atrial size was 5.5+/-0.9 cm, and ejection fraction was 61.3+/-13%. The surgical technique consisted of a circumferential incision surrounding the 4 pulmonary veins, excision of the left atrial appendage, and a perpendicular incision originating in the inferior margin of the circumferential incision isolating the pulmonary veins down to the mitral valve. Early arrhythmias were aggressively treated with cardioversion.


RESULTS
The mean follow-up was 23.9+/-17 months, and 3 patients died in the postoperative period. Ten patients required electrical cardioversion in the postoperative period; 87% had sinus rhythm in the last medical visit, and 33% were using amiodarone.


CONCLUSIONS
Isolation of the pulmonary veins associated with mitral valve surgery is an effective and safe technique for maintaining sinus rhythm in patients with permanent atrial fibrillation.
Lima
Gustavo G
GG
Instituto de Cardiologia do Rio Grande do Sul/Fundação Universitária de Cardiologia, Porto Alegre, RS, Brazil. pesquisa@cardnet.tche.br
Kalil
Renato A K
RA
Leiria
Tiago L L
TL
Vanni
Gustavo F
GF
Miglioransa
Marcelo H
MH
Faria-Corrêa
Daniel L
DL
Hatem
Domingos
D
Abrahão
Rogério
R
Sant'Anna
João R
JR
Prates
Paulo
P
Nesralla
Ivo A
IA
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000209:etiology / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000601:surgery*; D011184:Postoperative Period; D011667:Pulmonary Veins / Q000601:surgery*; D016896:Treatment Outcome