Seven-year experience with ablation of permanent atrial fibrillation concomitant to mitral valve surgery in 152 patients.
BACKGROUND
This study analyzed 7 years of results for monopolar endocardial radiofrequency (RF) ablation of permanent atrial fibrillation (pAF) concomitant to mitral valve (MV) surgery.


METHODS
Between 2001 and 2007, 152 patients who had experienced pAF for a median of 4.0 years (interquartile range, 1.5-8.0 years; range, 0.5-33 years) underwent monopolar endocardial RF ablation procedures (pulmonary vein isolation plus a connecting lesion) concomitant to MV surgery. All patients were reexamined to assess survival, conversion rate to stable sinus rhythm (SR), and New York Heart Association (NYHA) class at 8 +/- 1 days after surgery and follow-ups at 3 +/- 1 months and 41 +/- 24 months postoperatively. Data were analyzed exploratatively.


RESULTS
The survival rates at the 3 reexamination times were 97%, 95%, and 92%, respectively (6 cardiac and 6 noncardiac deaths), and the corresponding SR rates were 74%, 75%, and 73%. The NYHA class of the patients improved significantly after surgery (P = .006), particularly when a stable SR had been achieved (P = .039). Long-term pAF prior to surgery and a larger left atrium (LA) preoperatively were predictive of the return of postoperative AF (P = .0002, and P = .0003, respectively). Ninety-one percent of the patients with a preoperative pAF duration of <5 years and 88% of the patients with an LA size of <or=55 mm were in stable SR at the late follow-up. The cardiac rhythm at discharge and 3 months after surgery were predictive of a prognosis of long-term rhythm (P = .021, and P = .00002, respectively). Age, sex, and the underlying etiology of MV disease did not have a significant influence on postoperative cardiac rhythm.


CONCLUSIONS
This study demonstrated that a SR established after combined pAF ablation and MV surgery remains stable over time. Preoperative LA size and pAF duration are useful parameters for evaluating the success rate of pAF ablation concomitant to MV surgery.
Geidel
Stephan
S
Hanseatisches Herzzentrum, Abteilung für Herzchirurgie, Asklepios Klinik St. Georg, Hamburg, Germany. s.geidel@asklepios.com
Lass
Michael
M
Ostermeyer
Jörg
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000401:mortality* / Q000601:surgery*; D017115:Catheter Ablation / Q000401:mortality*; D015897:Comorbidity; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000401:mortality* / Q000601:surgery*; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome