title: Concomitant unipolar radiofrequency ablation of nonparoxysmal atrial fibrillation in rheumatic and degenerative valve disease.
abstract: OBJECTIVE
  The aim of this study was to compare the results of concomitant unipolar radiofrequency ablation of nonparoxysmal atrial fibrillation (AF) between rheumatic and degenerative valve disease (RHD versus DVD).
  
  
  METHODS
  Between 2005 and 2012, 96 patients underwent AF ablation with unipolar radiofrequency concurrently with heart valve surgery. They were followed in three months and at a median follow-up of 39 (18 to 61) months.
  
  
  RESULTS
  The mean age was 62 years old. Most patients had RHD (54.2%) and dilated left atria (LA, diameter 52.6 ± 5.8 mm). Patients with RHD were more likely to be younger and have larger LA. 88 patients (92%) underwent prophylactic closure of the left atrial appendage (LAA). Pulmonary vein-isolation, box lesion, LAA isolation, and left isthmus line were performed by radiofrequency, along with other right atrial cut-and-sew lines. Overall, surgical complications occurred in 25% of the patients and pacemaker implantation (17.7%) was the most frequently observed. In-hospital mortality rate was zero. The median length of stay was 8 (7, 12) days. Seventy-one percent of the patients were in sinus rhythm at discharge. Sinus rhythm maintenance was 45% and 40% in three months and at a median follow-up of 39 (18 to 61) months (269 patient-years), respectively. There was no statistically significant difference between RHD and DVD. In the multivariate analysis, LA ≥50 mm was the single independent predictor of AF recurrence at three months.
  
  
  CONCLUSIONS
  Radiofrequency ablation of AF concurrently with heart valve surgery is poorly effective in patients with multiple adverse risk factors. Patients with RHD and DVD had similar rates of sinus rhythm recovery. LA ≥50 mm was the single predictor of AF recurrence at three months.
authors.affiliation: Department of Physiology and Cardiothoracic Surgery, University of Porto, Porto, Portugal; Cardiovascular R&D Centre, Faculty of Medicine, University of Porto, Porto, Portugal.
authors.forename: Ana C
authors.initials: AC
authors.lastname: Pinho-Gomes
authors.forename: Mário J
authors.initials: MJ
authors.lastname: Amorim
authors.forename: Sílvia M
authors.initials: SM
authors.lastname: Oliveira
authors.forename: Luís
authors.initials: L
authors.lastname: Azevedo
authors.forename: Jorge
authors.initials: J
authors.lastname: Almeida
authors.forename: Maria Júlia
authors.initials: MJ
authors.lastname: Maciel
authors.forename: Paulo
authors.initials: P
authors.lastname: Pinho
authors.forename: Adelino F
authors.initials: AF
authors.lastname: Leite-Moreira
mesh_terms: D000367:Age Factors; D000368:Aged; D001281:Atrial Fibrillation / Q000209:etiology / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D017115:Catheter Ablation / Q000379:methods*; D004108:Dilatation, Pathologic; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006325:Heart Atria / Q000473:pathology; D006349:Heart Valve Diseases / Q000150:complications / Q000473:pathology / Q000601:surgery*; D006351:Heart Valves / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D012008:Recurrence; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000150:complications / Q000473:pathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome