Concomitant anti-arrhythmic procedures to treat permanent atrial fibrillation in CABG and AVR patients are as effective as in mitral valve patients.
OBJECTIVE
Concomitant anti-arrhythmic procedures, to treat permanent atrial fibrillation, are not routinely performed in non-mitral valve surgery, such as coronary artery bypass grafting (CABG) and aortic valve (AVR) procedures. This study evaluated the sinus rhythm (SR) conversion rate of a concomitant anti-arrhythmia procedure in non-mitral valve surgery compared to mitral valve surgery.


METHODS
Between 1997 and 2003, 128 patients with a documented permanent atrial fibrillation had a concomitant anti-arrhythmic procedure using unipolar endocardial radiofrequency ablation; 65 mitral valve surgery (group I) and 63 aortic valve surgery or CABG (group II). Follow-up was complete and included standard ECG and echocardiogram at 3, 6, 12 months and each consecutive year. Stability of SR was confirmed with a 24-h ECG registration.


RESULTS
Type of procedures was MVR 42 (32.8%), MVP 23 (18.0%), CABG 40 (31.2), AVR 21 (16.4%), other 2 (1.6%). Thirty-day mortality for groups I and II were 4.6% (3/65) and 3.2% (2/63). Group II patients were distinctly older (69.3 versus 64.8 years; P=0.04), but the size of the left atrium was smaller (45.9 versus 52.4mm; P=0.0001) and the aortic cross-clamp time was shorter (91 versus 99min; P=0.05). The cumulative postoperative SR percentages for the groups I and II patients at 12 months were 71 versus 79%. A bi-atrial contraction was observed in 65.6% (21/32) and 68.3% (28/41) of the groups I and II patients, who had a stable SR. The mean (SD) follow-up for groups I and II was 24.4 (19.4) and 21.0 (17.2) months. The cumulative survival rate at 1, 2 and 3 years for groups I and II were 85 versus 88%, 83 versus 85%, 79 versus 85% (log-rank test P=0.60).


CONCLUSIONS
A concomitant anti-arrhythmic procedure in CABG and AVR patients is as effective as in mitral valve patients, although these patients tend to be older, but with a smaller left atrial size.
Khargi
Krishna
K
Department of Cardiothoracic Surgery, Haga-Leyenburg Teaching Hospital, Leyweg 275, 2545 CH The Hague, The Netherlands. k.khargi@hagaziekenhuis.nl <k.khargi@hagaziekenhuis.nl>
Lemke
Bernd
B
Deneke
Thomas
T
D000328:Adult; D001021:Aortic Valve / Q000601:surgery*; D001281:Atrial Fibrillation / Q000601:surgery*; D017115:Catheter Ablation; D001026:Coronary Artery Bypass; D004452:Echocardiography; D004562:Electrocardiography; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D016015:Logistic Models; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D015996:Survival Rate; D016896:Treatment Outcome