Medium-term outcome of different surgical methods to cure atrial fibrillation: is less worse?
Different lesion sets and ablation techniques have been performed. We compared these outcomes in search of the best method. We performed a retrospective analysis of patients who have undergone AF surgery different from the maze III. The surgical lesion sets were pulmonary vein isolation (PVI) alone, left atrial maze (LAM) and bi-atrial maze (BAM) and were made with different ablation techniques. During surgery one patient died due to bleeding of a pulmonary vein. The number of patients in the PVI-, LAM-, BAM-groups was 12, 28 and 26, respectively, with freedom from AF at latest follow-up [22.0+/-15.6 (3.1-81.2) months] of 33%, 59% and 60%, respectively. Atrial flutter occurred less in the BAM-group (4%) than in the left-sided procedures (15.4%) (P=0.231). Multivariate analysis demonstrated a higher recurrence of AF for PVI alone (OR 4.42, CL 0.95-20.6, P=0.0583) and a lower recurrence for the 'cut-and-sew' technique (OR 0.13, CL 0.030-0.60, P=0.0084). Left- and bi-atrial maze procedures are equally effective in the suppression of AF, whereas omission of right-sided lesions results in a higher prevalence of atrial flutter. The 'cut-and-sew' technique is superior in terms of freedom from AF compared to bipolar and unipolar radiofrequency.
Department of Cardio-Thoracic Surgery, St Antonius Hospital, Nieuwegein, The Netherlands.
Guillaume S C
GS
Geuzebroek
Philippe K E W
PK
Ballaux
Norbert M
NM
van Hemel
Johannes C
JC
Kelder
Jo J A M T
JJ
Defauw
D000368:Aged; D020517:Atrial Appendage / Q000601:surgery; D001281:Atrial Fibrillation / Q000401:mortality / Q000601:surgery*; D001282:Atrial Flutter / Q000209:etiology; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011667:Pulmonary Veins / Q000601:surgery; D012008:Recurrence; D012107:Research Design; D012189:Retrospective Studies; D018570:Risk Assessment; D013997:Time Factors; D016896:Treatment Outcome