title: Permanent chronic atrial fibrillation: is pulmonary vein isolation alone enough?
abstract: BACKGROUND
  The efficacy of mere pulmonary vein isolation epicardially for the treatment of permanent chronic atrial fibrillation, in comparison with the left atrial endocardial maze procedure was evaluated.
  
  
  METHODS
  Retrospective data collection and analysis toward the outcome of 72 consecutive patients who underwent left atrial maze procedures between January 2003 and December 2005 was performed. Surgical ablation was performed concomitantly with valve and (or) coronary procedures. Group I (n = 29) received an endocardial left atrial ablation using unipolar saline irrigated radiofrequency (Medtronic Cardioblate surgical ablation pen; Medtronic Inc, Minneapolis, MN). Group II (n = 43) received epicardial isolation of the pulmonary veins using bipolar saline irrigated radiofrequency (Medtronic Cardioblate). Follow-up included 24h electrocardiogram and echocardiography 6 and 12 months postoperatively.
  
  
  RESULTS
  Mean follow-up was 19.5 +/- 1.0 months (17.7 +/- 19.5 months group I vs 20.6 +/- 1.1 months group II). Both groups were comparable with regard to duration of preoperative atrial fibrillation, European system for cardiac operative risk evaluation, left ventricular ejection fraction, aortic cross-clamp time, bypass time, intensive care unit and hospital stay (p > 0.05). No maze procedure-related mortality was observed. In group I, three patients required postoperative pacemaker implantation due to atrioventricular (AV) bloc, bradycardia, and sick sinus syndrome, respectively. In group II, five patients required postoperative pacemaker implantation (three AV bloc and two bradycardia). Freedom from atrial fibrillation at last follow-up was 85.7% and 58.5% in groups I and II, respectively (p = 0.016).
  
  
  CONCLUSIONS
  Pulmonary vein isolation alone seems to be insufficient in treating permanent chronic atrial fibrillation. In case of chronic permanent atrial fibrillation, left atrial endocardial maze, providing the connection lines to the mitral annulus and (or) between the pulmonary veins, seems to be mandatory.
authors: Department of Cardiothoracic Surgery, Medical University of Vienna, Vienna, Austria. wilfried.wisser@meduniwien.ac.at
authors: Wilfried
authors: W
authors: Wisser
authors: Gernot
authors: G
authors: Seebacher
authors: Tatjana
authors: T
authors: Fleck
authors: Clemens
authors: C
authors: Aigner
authors: Cäsar
authors: C
authors: Khazen
authors: Günter
authors: G
authors: Stix
authors: Doris
authors: D
authors: Hutschala
authors: Ernst
authors: E
authors: Wolner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001281:Atrial Fibrillation / Q000150:complications / Q000601:surgery*; D002315:Cardiopulmonary Bypass / Q000379:methods; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D002908:Chronic Disease; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D011336:Probability; D011667:Pulmonary Veins / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome