title: Biatrial or Left Atrial Lesion Set for Ablation During Mitral Surgery: Risks and Benefits.
abstract: BACKGROUND
  Controversy exists when performing surgical atrial fibrillation ablation whether there is an increase in postoperative complications using biatrial (BA) lesions compared with only left atrial (LA) lesions, and some studies indicate similar efficacy. This study compares the clinical outcomes of BA and LA ablation lesions in mitral valve surgery patients.
  
  
  METHODS
  From 2004 through 2014, 2,137 patients had mitral valve surgery with or without other surgeries in a single center. Of those, 836 (39%) had preoperative atrial fibrillation, and of those, 724 (86%) underwent atrial fibrillation ablation surgery; 257 patients had BA lesion sets and 359 had LA lesion sets. Propensity score matching of BA and LA patients was performed.
  
  
  RESULTS
  Baseline differences included more postoperative complications in the BA group, specifically, permanent pacemaker placement (13% versus 7%; p = 0.006). Freedom from atrial fibrillation off antiarrhythmic drugs (72% BA versus 75% LA; p = 0.50), postoperative ablation (7% BA versus 5% LA; p = 0.20), stroke (0.11 versus 0.11 per 10 person-years; p = 0.91), and survival were similar between the groups. After matching, patients in the LA group had a higher freedom from postoperative ablation (p = 0.015), but no difference in freedom from atrial fibrillation off antiarrhythmic drugs (79% BA versus 69% LA; p = 0.09), and no difference in permanent pacemaker placement (10% versus 12%; p = 0.57).
  
  
  CONCLUSIONS
  Patients undergoing mitral surgery with LA or BA ablation had similar outcomes, survival, and complications. Limiting lesions to the LA is an effective alternative to BA ablation for patients undergoing ablation with concomitant mitral valve surgery.
authors.affiliation: Department of Surgery, Bluhm Cardiovascular Institute, Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, Illinois.
authors.forename: Andrei
authors.initials: A
authors.lastname: Churyla
authors.affiliation: Department of Surgery, Bluhm Cardiovascular Institute, Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, Illinois; Department of Surgery, Yale University, Yale-New Haven Hospital, New Haven, Connecticut.
authors.forename: Adam
authors.initials: A
authors.lastname: Iddriss
authors.affiliation: Department of Surgery, Bluhm Cardiovascular Institute, Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, Illinois.
authors.forename: Adin-Christian
authors.initials: AC
authors.lastname: Andrei
authors.affiliation: Department of Surgery, Bluhm Cardiovascular Institute, Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, Illinois.
authors.forename: Jane
authors.initials: J
authors.lastname: Kruse
authors.affiliation: Department of Surgery, Bluhm Cardiovascular Institute, Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, Illinois.
authors.forename: S Chris
authors.initials: SC
authors.lastname: Malaisrie
authors.affiliation: Department of Cardiology, Bluhm Cardiovascular Institute, Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, Illinois.
authors.forename: Rod
authors.initials: R
authors.lastname: Passman
authors.affiliation: Department of Surgery, Bluhm Cardiovascular Institute, Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, Illinois.
authors.forename: Zhi
authors.initials: Z
authors.lastname: Li
authors.affiliation: Center for Comprehensive Cardiovascular Care, Saint Louis University, St Louis, Missouri.
authors.forename: Richard
authors.initials: R
authors.lastname: Lee
authors.affiliation: Department of Surgery, Bluhm Cardiovascular Institute, Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, Illinois. Electronic address: pmccart@nm.org.
authors.forename: Patrick M
authors.initials: PM
authors.lastname: McCarthy
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000209:etiology / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D017115:Catheter Ablation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000601:surgery*; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D057216:Propensity Score; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D016896:Treatment Outcome