title: Efficacy of catheter ablation and surgical CryoMaze procedure in patients with long-lasting persistent atrial fibrillation and rheumatic heart disease: a randomized trial.
abstract: OBJECTIVE
  Catheter ablation and surgical Maze procedure are effective in treating atrial fibrillation (AF) patients. However, there is no study that compares the effect of circumferential pulmonary vein isolation (CPVI) combined with substrate ablation after valvular surgery and the concomitant Maze procedure for the treatment of AF in patients with rheumatic heart disease (RHD). The aim of this study was to compare the effectiveness of CPVI combined with substrate modification and surgical Maze procedure using Saline-Irrigated Cooled-tip Radiofrequency Ablation (SICTRA) system for the treatment of long-lasting persistent AF in patients with RHD.
  
  
  RESULTS
  Between January 2006 and June 2008, 99 patients with long-lasting persistent AF and RHD were randomly assigned to undergo valvular operation and CPVI combined with substrate modification 6 months after the surgery (Group A, 49 patients) or valvualr operation and concomitant Maze procedure (Group B, 50 patients). The mean follow-up periods were 15 ± 5 and 20 ± 8 months in Groups A and B, respectively. After one procedure, Group B had a significantly higher freedom from artial arrhythmias compared with Group A (82% in Group B vs. 55.2% in Group A, P < 0.001). Fifteen patients in Group A underwent a redo procedure. Six patients in Group B underwent catheter ablation and four were treated successfully. The cumulative rates of sinus rhythm were 71% in Group A and 88% in Group B (P < 0.001).
  
  
  CONCLUSIONS
  The concomitant Cox Maze procedure using SICTRA is more effective than subsequent CPVI combined with substrate modification in treating patients with long-lasting persistent AF and RHD.
authors.affiliation: Department of Cardiology, Shanghai Chest Hospital Affiliated to Shanghai Jiaotong University, Shanghai 200030, China. xkliuxu@126.com
authors.forename: Xu
authors.initials: X
authors.lastname: Liu
authors.forename: Hong-Wei
authors.initials: HW
authors.lastname: Tan
authors.forename: Xin-Hua
authors.initials: XH
authors.lastname: Wang
authors.forename: Hai-Feng
authors.initials: HF
authors.lastname: Shi
authors.forename: Ying-Ze
authors.initials: YZ
authors.lastname: Li
authors.forename: Feng
authors.initials: F
authors.lastname: Li
authors.forename: Li
authors.initials: L
authors.lastname: Zhou
authors.forename: Jia-Ning
authors.initials: JN
authors.lastname: Gu
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000209:etiology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D002908:Chronic Disease; D004594:Electrophysiology; D006324:Heart Arrest, Induced / Q000379:methods; D006351:Heart Valves / Q000601:surgery*; D006495:Heparin, Low-Molecular-Weight / Q000627:therapeutic use; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D011182:Postoperative Care / Q000379:methods; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000601:surgery*; D012008:Recurrence; D012214:Rheumatic Heart Disease / Q000150:complications*; D016896:Treatment Outcome
chemical_list: D000925:Anticoagulants; D006495:Heparin, Low-Molecular-Weight