title: Maintenance of sinus rhythm after electrical cardioversion for recurrent atrial fibrillation following mitral valve surgery with or without associated radiofrequency ablation.
abstract: BACKGROUND
  This study reports the outcomes of patients who underwent electrical cardioversion for atrial fibrillation recurrence following mitral valve surgery and associated radiofrequency ablation compared to those who did not undergo concomitant atrial fibrillation ablation.
  
  
  METHODS
  The population consisted of 116 patients with persistent/long-standing persistent AF who underwent mitral valve surgery with (Group A, n=54) or without (Group B, n=62) associated radiofrequency ablation between January 2007 and January 2011 at three institutions and who subsequently underwent cardioversion for persistent atrial fibrillation within 12 months of their initial procedure.
  
  
  RESULTS
  The mean follow-up duration was 30.7±9.4 months. Of the 104 patients with acute restoration of SR 42 (40.3%) had AF recurrence. The average time to recurrence after cardioversion was 7.3±4.2 days. Recurrence was significantly lower in patients undergoing ablation surgery (21.4%) than in those undergoing no ablation surgery (78.6%, p<0.001). Non-performed ablation procedure (p<0.001), time from surgery≥88 days and left atrial dimensions≥45.5 mm before cardioversion (both, p=0.005) were multivariable predictors of atrial fibrillation recurrence. In Group B the use of amiodarone was inversely correlated with recurrence of AF (p<0.001). This correlation was not significant (r=-0.02, p=0.85) in Group A.
  
  
  CONCLUSIONS
  Electrical cardioversion for recurrent AF showed better results and stable recovery of sinus rhythm in patients undergoing concomitant surgical ablation during mitral valve surgery. This might be attributable to substrate modification caused by surgical lesions. Amiodarone improved the ECV-success rate only in patients with no associate ablation. Further larger randomized studies are necessary to confirm our findings.
authors.affiliation: University Hospital, Maastricht, The Netherlands.
authors.forename: Henrica N A M
authors.initials: HN
authors.lastname: van Breugel
authors.affiliation: University Hospital, Maastricht, The Netherlands; Careggi Hospital, Florence Italy. Electronic address: sandro.gelsomino@maastrichtuniversity.nl.
authors.forename: Sandro
authors.initials: S
authors.lastname: Gelsomino
authors.affiliation: University Hospital, Maastricht, The Netherlands.
authors.forename: Cees B
authors.initials: CB
authors.lastname: de Vos
authors.affiliation: University Hospital, Maastricht, The Netherlands.
authors.forename: Ryan E
authors.initials: RE
authors.lastname: Accord
authors.affiliation: University Hospital, Maastricht, The Netherlands.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Tieleman
authors.affiliation: Careggi Hospital, Florence Italy.
authors.forename: Fabiana
authors.initials: F
authors.lastname: Lucà
authors.affiliation: Careggi Hospital, Florence Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Rostagno
authors.affiliation: University of Magna Graecia, Catanzaro, Italy.
authors.forename: Attilio
authors.initials: A
authors.lastname: Renzulli
authors.affiliation: University Hospital, Maastricht, The Netherlands; University of Magna Graecia, Catanzaro, Italy.
authors.forename: Orlando
authors.initials: O
authors.lastname: Parise
authors.affiliation: University of Magna Graecia, Catanzaro, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Lorusso
authors.affiliation: University Hospital, Maastricht, The Netherlands.
authors.forename: Harry J G M
authors.initials: HJ
authors.lastname: Crijns
authors.affiliation: University Hospital, Maastricht, The Netherlands.
authors.forename: Jos G
authors.initials: JG
authors.lastname: Maessen
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods; D004554:Electric Countershock / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000502:physiology / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Ablation surgery; Atrial fibrillation; Electrical cardioversion