title: Surgical ablation of atrial fibrillation during mitral-valve surgery.
abstract: BACKGROUND
  Among patients undergoing mitral-valve surgery, 30 to 50% present with atrial fibrillation, which is associated with reduced survival and increased risk of stroke. Surgical ablation of atrial fibrillation has been widely adopted, but evidence regarding its safety and effectiveness is limited.
  
  
  METHODS
  We randomly assigned 260 patients with persistent or long-standing persistent atrial fibrillation who required mitral-valve surgery to undergo either surgical ablation (ablation group) or no ablation (control group) during the mitral-valve operation. Patients in the ablation group underwent further randomization to pulmonary-vein isolation or a biatrial maze procedure. All patients underwent closure of the left atrial appendage. The primary end point was freedom from atrial fibrillation at both 6 months and 12 months (as assessed by means of 3-day Holter monitoring).
  
  
  RESULTS
  More patients in the ablation group than in the control group were free from atrial fibrillation at both 6 and 12 months (63.2% vs. 29.4%, P<0.001). There was no significant difference in the rate of freedom from atrial fibrillation between patients who underwent pulmonary-vein isolation and those who underwent the biatrial maze procedure (61.0% and 66.0%, respectively; P=0.60). One-year mortality was 6.8% in the ablation group and 8.7% in the control group (hazard ratio with ablation, 0.76; 95% confidence interval, 0.32 to 1.84; P=0.55). Ablation was associated with more implantations of a permanent pacemaker than was no ablation (21.5 vs. 8.1 per 100 patient-years, P=0.01). There were no significant between-group differences in major cardiac or cerebrovascular adverse events, overall serious adverse events, or hospital readmissions.
  
  
  CONCLUSIONS
  The addition of atrial fibrillation ablation to mitral-valve surgery significantly increased the rate of freedom from atrial fibrillation at 1 year among patients with persistent or long-standing persistent atrial fibrillation, but the risk of implantation of a permanent pacemaker was also increased. (Funded by the National Institutes of Health and the Canadian Institutes of Health Research; ClinicalTrials.gov number, NCT00903370.).
authors: The authors' affiliations are listed in the Appendix.
authors: A Marc
authors: AM
authors: Gillinov
authors: Annetine C
authors: AC
authors: Gelijns
authors: Michael K
authors: MK
authors: Parides
authors: Joseph J
authors: JJ
authors: DeRose
authors: Alan J
authors: AJ
authors: Moskowitz
authors: Pierre
authors: P
authors: Voisine
authors: Gorav
authors: G
authors: Ailawadi
authors: Denis
authors: D
authors: Bouchard
authors: Peter K
authors: PK
authors: Smith
authors: Michael J
authors: MJ
authors: Mack
authors: Michael A
authors: MA
authors: Acker
authors: John C
authors: JC
authors: Mullen
authors: Eric A
authors: EA
authors: Rose
authors: Helena L
authors: HL
authors: Chang
authors: John D
authors: JD
authors: Puskas
authors: Jean-Philippe
authors: JP
authors: Couderc
authors: Timothy J
authors: TJ
authors: Gardner
authors: Robin
authors: R
authors: Varghese
authors: Keith A
authors: KA
authors: Horvath
authors: Steven F
authors: SF
authors: Bolling
authors: Robert E
authors: RE
authors: Michler
authors: Nancy L
authors: NL
authors: Geller
authors: Deborah D
authors: DD
authors: Ascheim
authors: Marissa A
authors: MA
authors: Miller
authors: Emilia
authors: E
authors: Bagiella
authors: Ellen G
authors: EG
authors: Moquete
authors: Paula
authors: P
authors: Williams
authors: Wendy C
authors: WC
authors: Taddei-Peters
authors: Patrick T
authors: PT
authors: O'Gara
authors: Eugene H
authors: EH
authors: Blackstone
authors: Michael
authors: M
authors: Argenziano
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000517:prevention & control / Q000601:surgery*; D002318:Cardiovascular Diseases / Q000401:mortality; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D015716:Electrocardiography, Ambulatory; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D011183:Postoperative Complications; D011788:Quality of Life; D055502:Secondary Prevention