title: Impact of lesion sets on mid-term results of surgical ablation procedure for atrial fibrillation.
abstract: OBJECTIVE
  The objective of this study was to evaluate the effects of different lesion sets of ablation in patients undergoing mitral surgery plus maze.
  
  
  BACKGROUND
  The role of lesion sets on outcome after maze is poorly defined.
  
  
  METHODS
  A total of 141 patients were prospectively followed up. Two different lesion sets were prepared: 32 patients underwent a radiofrequency left atrial lesion set of maze ("limited"), and 109 had combined left and right atrial lesion sets of maze ± ganglionic plexi isolation ("extensive"). A longitudinal observational study assessed the role of "extensive" versus "limited" ablation on atrial fibrillation (AF), New York Heart Association (NYHA) functional class II/III, treatment with antiarrhythmic drugs, follow-up recovery of the ratio of E- to A-wave (E/A), and survival and time to hospitalization (overall and for heart failure).
  
  
  RESULTS
  The prevalence of AF over time was lower in the "extensive" arm (adjusted relative risk [RR]: 0.10; 95% confidence interval [CI]: 0.03 to 0.31; p < 0.001), with significantly lower prevalence at discharge, 3 months, and 18 months. The prevalence of patients in NYHA functional class II/III over time was lower in the "extensive" arm (adjusted RR: 0.11; 95% CI: 0.03 to 0.34; p < 0.001), with significant differences at any assessment (except the third month). The differences in E/A recovery and use of antiarrhythmic drugs were less marked, with an RR of 1.55 (95% CI: 0.99 to 2.42; p = 0.05) and RR of 0.76 (95% CI: 0.54 to 1.06; p = 0.11), respectively, with a significantly lower prevalence of antiarrhythmic drugs in the "extensive" ablation arm at 12, 18, and 24 months. Rates of hospitalization for heart failure, overall hospitalization, and the combined event death/hospitalization were lower in the "extensive" arm (p = 0.11, p = 0.003, and p = 0.002, respectively).
  
  
  CONCLUSIONS
  The addition of right-sided ablation improves clinical and electrophysiologic results after maze procedure.
authors.affiliation: Division of Cardiac Surgery, University of Verona Medical School, Italy. frankono@libero.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Onorati
authors.forename: Giovanni
authors.initials: G
authors.lastname: Mariscalco
authors.forename: Antonino Salvatore
authors.initials: AS
authors.lastname: Rubino
authors.forename: Filiberto
authors.initials: F
authors.lastname: Serraino
authors.forename: Francesco
authors.initials: F
authors.lastname: Santini
authors.forename: Andrea
authors.initials: A
authors.lastname: Musazzi
authors.forename: Catherine
authors.initials: C
authors.lastname: Klersy
authors.forename: Andrea
authors.initials: A
authors.lastname: Sala
authors.forename: Attilio
authors.initials: A
authors.lastname: Renzulli
mesh_terms: D017677:Age Distribution; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D015331:Cohort Studies; D016001:Confidence Intervals; D004562:Electrocardiography / Q000379:methods; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D019990:Perioperative Care / Q000379:methods; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011379:Prognosis; D012008:Recurrence; D012720:Severity of Illness Index; D017678:Sex Distribution; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome