title: Epicardial atrial mapping can predict elimination of chronic atrial fibrillation after the box pulmonary vein isolation during mitral valve surgery.
abstract: BACKGROUND
  The pulmonary veins (PV) and posterior left atrium (LA) may contribute to the occurrence and maintenance of atrial fibrillation (AF). We evaluated whether simple epicardial electrophysiological mapping can predict elimination of chronic AF after the box PV isolation procedure.
  
  
  RESULTS
  Using a computerized 48-channel mapping system, we performed intraoperative atrial mapping in 16 patients with chronic AF associated with mitral valve (MV) disease. Patients' ages ranged from 48 to 76 years (mean, 61.4 years). AF duration ranged from 1 to 16 years (mean, 7.5±5.4 years). Simple box PV isolation was performed during the MV operation. Regular and repetitive activation was found in the LA of 12 of 16 patients, and irregular and chaotic activation was found in both atria in 4 of 16 patients; 12 patients with regular and repetitive activation of the LA were treated by box PV isolation and the other 4 patients with irregular and chaotic activation in both atria did not recover sinus rhythm after this procedure. AF-free rate was significantly higher in patients with regular and repetitive activation of the LA (P<0.01).
  
  
  CONCLUSIONS
  Box PV isolation was effective in the treatment of chronic AF associated with MV disease. Epicardial atrial mapping may predict elimination of AF after the box PV isolation.
authors.affiliation: Department of Cardiovascular Surgery, Hiroshima University School of Medicine, Hiroshima 734-8551, Japan. sueda@hiroshima-u.ac.jp
authors.forename: Taijiro
authors.initials: T
authors.lastname: Sueda
authors.forename: Naomichi
authors.initials: N
authors.lastname: Uchida
authors.forename: Shinya
authors.initials: S
authors.lastname: Takahashi
authors.forename: Taiichi
authors.initials: T
authors.lastname: Takasaki
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Kurosaki
authors.forename: Keijiro
authors.initials: K
authors.lastname: Katayama
authors.forename: Katsuhiko
authors.initials: K
authors.lastname: Imai
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D002908:Chronic Disease; D003452:Cryosurgery / Q000009:adverse effects / Q000401:mortality; D022062:Electrophysiologic Techniques, Cardiac; D005260:Female; D006325:Heart Atria / Q000503:physiopathology; D006349:Heart Valve Diseases / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery*; D010496:Pericardium / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome