title: Assessment of concomitant paroxysmal atrial fibrillation ablation in mitral valve surgery patients based on continuous monitoring: does a different lesion set matter?
abstract: OBJECTIVE
  The efficacy of concomitant ablation techniques in patients with paroxysmal atrial fibrillation (AF) undergoing mitral valve surgery remains under debate. The aim of this prospective, randomized, single-centre study was to compare pulmonary vein isolation (PVI) only versus a left atrial maze (LAM) procedure in patients with paroxysmal AF during mitral valve surgery.
  
  
  METHODS
  Between February 2009 and June 2011, 52 patients with a mean age of 54.2 (standard deviation 7.2 years) underwent mitral valve surgery and concomitant bipolar radiofrequency ablation for paroxysmal AF. Patients were randomized into the PVI group (n = 27) and the LAM group (n = 25). After surgery, an implantable loop recorder for continuous electrocardiography (ECG) monitoring was implanted. Patients with an AF burden (AF%) of <0.5% were considered AF free (responders). The mean follow-up was 18.6 months (standard deviation 2.1 months), and the patient' data were evaluated every 3 months.
  
  
  RESULTS
  All patients were alive at discharge. No procedure-related complications occurred for either the ablation or the loop recorder implantation. Mean aortic clamping and ablation times were significantly longer in the LAM group than in the PVI group. The incidence of early AF paroxysm recurrence was significantly higher in the PVI group than in the LAM group (62.9 vs 24.0%, P < 0.001). At 20 months after surgery, 15 (55.6%) of the 27 patients in the PVI group and 22 (88.0%) of the 25 patients in the LAM group had no documented atrial arrhythmias and were considered responders (AF burden <0.5%). The mean AF burden during all follow-up periods was significantly lower in the LAM group (23.6 ± 8.7%) than in the PVI group (6.8 ± 2.2%) (P < 0.001).
  
  
  CONCLUSIONS
  According to continuous ECG monitoring data, freedom from AF was significantly higher after the concomitant LAM procedure than after PVI in patients with paroxysmal AF who underwent mitral valve surgery.
authors.affiliation: Heart Valves Surgery Department, State Research Institute of Circulation Pathology, Novosibirsk, Russian Federation.
authors.forename: Alexandr
authors.initials: A
authors.lastname: Bogachev-Prokophiev
authors.forename: Sergey
authors.initials: S
authors.lastname: Zheleznev
authors.forename: Alexey
authors.initials: A
authors.lastname: Pivkin
authors.forename: Evgeny
authors.initials: E
authors.lastname: Pokushalov
authors.forename: Alexander
authors.initials: A
authors.lastname: Romanov
authors.forename: Vladimir
authors.initials: V
authors.lastname: Nazarov
authors.forename: Alexander
authors.initials: A
authors.lastname: Karaskov
mesh_terms: D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D017115:Catheter Ablation / Q000009:adverse effects; D015716:Electrocardiography, Ambulatory; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011667:Pulmonary Veins / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012426:Russia; D013997:Time Factors; D016896:Treatment Outcome
keywords: Atrial fibrillation; Continuous electrocardiography monitoring; Mitral valve surgery; Radiofrequency ablation