title: Pulmonary vein isolation for persistent atrial fibrillation. Long-term results.
abstract: BACKGROUND
  Pulmonary vein isolation has been employed to eliminate paroxysmal atrial fibrillation. However, the long-term outcome in terms of long-standing persistent atrial fibrillation is unclear.
  
  
  METHODS
  One hundred patients with rheumatic mitral valve disease and long-standing (>1 year) persistent atrial fibrillation were operated on between July 1998 and June 2007. Mitral valve surgery and surgical isolation (cut-and-sew) of the pulmonary veins were performed in all cases. Transthoracic echocardiography and 24-h Holter monitoring were obtained after 3 and 6 months and yearly thereafter.
  
  
  RESULTS
  Early and late follow-up was 99% and 92% complete, respectively. The endpoint was freedom from atrial fibrillation. There was one (1%) hospital death. Atrial fibrillation was present in 39%, 47%, 63% and 68% of patients at 3 months, 1 year, 3 years, and 5 years after surgery, respectively. The odds ratios for recurrence of atrial fibrillation postoperatively were 1.41 (95% confidence interval 1.14-1.74), 2.17 (95% confidence interval 1.63-2.90), and 3.62 (95% confidence interval 2.44-5.38) at 1 week, 3 years, and 5 years, respectively. Actuarial freedom from atrial fibrillation was 35% at 3 years, and 30% at 5 years. A direct relationship was observed between preoperative left atrial size >6 cm and atrial fibrillation recurrence at 5 years (p < 0.05 odds ratio = 2.5, 95% confidence interval 1.15 - 5.4).
  
  
  CONCLUSIONS
  No beneficial effects of simple pulmonary vein isolation for long-standing persistent atrial fibrillation concomitant with rheumatic mitral valve disease were observed. Atrial fibrillation cannot be fully treated using only pulmonary vein isolation.
authors.affiliation: Department of Cardiac Surgery. Hospital of Cardiology UMAE 34, IMSS, Monterrey, Nuevo Leon, Mexico ovidiogv@hotmail.com.
authors.forename: Ovidio A
authors.initials: OA
authors.lastname: Garcia-Villarreal
mesh_terms: D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000601:surgery*; D002908:Chronic Disease; D015716:Electrocardiography, Ambulatory; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D011667:Pulmonary Veins / Q000601:surgery*; D016896:Treatment Outcome; D014463:Ultrasonography
keywords: Atrial fibrillation; Cardiac surgical procedures; Heart atria; Mitral valve; Pulmonary veins