Effect of surgery for atrial fibrillation associated with mitral valve disease.
BACKGROUND
The purpose of this study is to evaluate the effect of surgery for atrial fibrillation (AF) associated with mitral valve disease.


METHODS
From September 1994 to December 2006, 244 patients who underwent mitral valve surgery were enrolled in this study. The maze procedure or pulmonary vein isolation was concomitantly performed in 147 patients, while the remaining 97 patients were not surgically treated for AF. The patients were divided into 3 groups based on their cardiac rhythm at discharge from the hospital: the sinus group (108 patients), the intractable AF group (39 patients), and the untreated AF group (97 patients). The clinical features and late results of patients were compared among these groups.


RESULTS
Early mortality rate was 0.7% and no major morbid events had occurred. Follow-up was completed in 95.6% of the patients and the mean follow-up period was 6.03 years. Actuarial survival was not significant between the sinus and AF groups. Actuarial freedom from thromboembolism at 5 and 10 years was 96.5% in the sinus group, 82.4% and 78.1%, respectively, in the intractable AF group, and 93.4% and 89.1%, respectively, in the untreated AF group; statistical significance was observed among the 3 groups (p = 0.01). By means of multivariate analysis, intractable AF was found to be the only risk factor for thromboembolism and other complications.


CONCLUSIONS
Atrial fibrillation associated with mitral valve disease should be treated, because restoration of the sinus rhythm might lead to a lower incidence of thromboembolism and valve-related complications in the later period.
Fukunaga
Shuji
S
Department of Surgery, Kurume University School of Medicine, Kurume, Japan. shuji@med.kurume-u.ac.jp
Hori
Hidetsugu
H
Ueda
Tomohiro
T
Takagi
Kazuyoshi
K
Tayama
Eiki
E
Aoyagi
Shigeaki
S
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000704:Analysis of Variance; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods; D002423:Cause of Death; D004562:Electrocardiography; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve; D011183:Postoperative Complications / Q000401:mortality; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution