title: Surgical treatment of atrial fibrillation using cryothermy in patients undergoing mitral valve surgery.
abstract: Surgical treatment of atrial fibrillation (AF) using a variety of energy sources and a mixture of lesion sets has become an important adjunct in patients undergoing cardiac surgery. We retrospectively analyzed prospectively collected data of 141 patients with a history of AF (mean duration of AF 35+/-39 months; intermittent AF: n=72; 51%; permanent AF: 69 (49%)) who underwent a left-sided Cryomaze procedure in conjunction with mitral valve (MV) surgery between January 2003 and September 2006. Freedom from AF was 77% at discharge and 87% at a mean follow-up of 305+/-195 days with a decreasing rate of AF during the first 3-9 months from 13% to 9% and an increase beyond the first year (29% at 2 years). Predictors of failed Cryomaze in multivariate analysis were left atrial size >50 mm (OR=5.7), AF at surgery (OR=5.0) and cardiac reoperation (OR=3.4), whereas preoperative beta-blocker treatment was a predictor of success (OR=0.2). Our data suggest that a left-sided Cryomaze procedure effectively restores sinus rhythm in patients with AF undergoing MV surgery. The success rate should not be evaluated immediately postoperatively because there is a steady increase in the rate of patients with freedom from AF in the first year. It appears, however, that there is a higher rate of recurrence during later follow-up.
authors.affiliation: Department of Cardiothoracic Surgery, Mount Sinai School of Medicine, Mount Sinai Hospital, New York, NY 10029-1028, USA.
authors.forename: Parwis B
authors.initials: PB
authors.lastname: Rahmanian
authors.forename: Farzan
authors.initials: F
authors.lastname: Filsoufi
authors.forename: Sacha
authors.initials: S
authors.lastname: Salzberg
authors.forename: Anthony
authors.initials: A
authors.lastname: Coppolino
authors.forename: Javier G
authors.initials: JG
authors.lastname: Castillo
authors.forename: David H
authors.initials: DH
authors.lastname: Adams
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D003452:Cryosurgery / Q000009:adverse effects / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000401:mortality / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016017:Odds Ratio; D012008:Recurrence; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome