title: Left atrial radiofrequency ablation associated with valve surgery: midterm outcomes.
abstract: BACKGROUND
  Left atrial ablation is a surgical standard technique for the treatment of persistent or chronic atrial fibrillation (p-AF and c-AF, respectively).Objective The aim of the study is to evaluate midterm results of left atrial ablation according to modified Maze procedure in patients affected by p-AF or c-AF and concomitant mitral or aortic valve disease requiring surgical treatment.
  
  
  METHODS
  A total of 108 patients (age, mean ± standard deviation [SD]: 66 ± 8.5 years) underwent left atrial ablation by means of unipolar (n = 62) or bipolar (n = 66) radiofrequency for p-AF (n = 28) or c-AF (n = 100) in association with mitral (n = 93) or mitral and aortic valve (n = 35) surgery.
  
  
  RESULTS
  In-hospital mortality was 0.8%. Patients with preoperative c-AF had preoperative greater value of left atrial diameter (56.7 ± 7.4 vs. 52 ± 9 mm, p = 0.05) than those with p-AF. At 9 years after Maze procedure, 86% (n = 24/28) of patients with preoperative p-AF were in sinus rhythm versus 28% (n = 27/95) with c-AF (p < 0.0001). Preoperative c-AF and left atrial diameter of 75 mm or more predicted atrial fibrillation recurrence. In patients in sinus rhythm compared with those in residual atrial fibrillation, survival was 100 versus 86% ± 6.4%, New York Heart Association class was 1.3 ± 0.5 versus 1.7 ± 0.6, and need of lifelong anticoagulation therapy was 43 versus 91% (p < 0.05, for all comparisons).
  
  
  CONCLUSIONS
  Left atrial Maze procedure for p-AF offers better chances to conversion in sinus rhythm as compared with long-standing c-AF. Survival, functional status, and quality of life are superior in patients who benefit from sinus rhythm.
authors.affiliation: Division of Cardiac Surgery, Policlinico Universitario Tor Vergata, Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Nardi
authors.forename: Charles
authors.initials: C
authors.lastname: Mve Mvondo
authors.forename: Charles Mve
authors.initials: CM
authors.lastname: Mvondo
authors.forename: Antonio
authors.initials: A
authors.lastname: Scafuri
authors.forename: Antonio
authors.initials: A
authors.lastname: Pellegrino
authors.forename: Francesca
authors.initials: F
authors.lastname: D'Auria
authors.forename: Patrizio
authors.initials: P
authors.lastname: Polisca
authors.forename: Jacob
authors.initials: J
authors.lastname: Zeitani
authors.forename: Luigi
authors.initials: L
authors.lastname: Chiariello
mesh_terms: D000368:Aged; D001021:Aortic Valve / Q000503:physiopathology / Q000601:surgery; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016279:Atrial Function, Left; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000401:mortality; D017115:Catheter Ablation / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D002908:Chronic Disease; D005260:Female; D006325:Heart Atria / Q000503:physiopathology / Q000601:surgery; D006349:Heart Valve Diseases / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome