Atrial Size Reduction as a Predictor of the Success of Radiofrequency Maze Procedure for Chronic Atrial Fibrillation in Patients Undergoing Concomitant Valvular Surgery

Chen, Mien‐Cheng; Chang, Jen‐Ping; Guo, G. Bih-Fang; Chang, Hsueh‐Wen

doi:10.1046/j.1540-8167.2001.00867.x

Cited by 87 publications

(77 citation statements)

References 4 publications

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“…Instead, it revealed that there were only 2 significant factors associated with the successful maintenance of SR: increase in the MV area and decrease in the LA size by PTMV. These findings are consistent with those of a recent study 18 in which atrial size reduction, not AF duration or preoperative atrial size, was found to predict the success of conversion and maintenance of SR in rheumatic AF patients undergoing concomitant radiofrequency maze procedure and valvular surgery.…”

Section: Predictors Of Successful Maintenance Of Sr In Rheumatic Af Asupporting

confidence: 92%

“…Catheter ablation is seldom performed in rheumatic AF patients, 23 but in those studies that have used it, the success rate was limited. 11,12 The intra-operative radiofrequency maze procedure 18 is an option only for patients undergoing concomitant open-heart surgery for MV replacement. Thus, the strategy we studied here represents a feasible alternative treatment option in select patients after PTMV and may be justified in patients subject to the possible risk of sideeffects from long-term amidarone use, because AF can be converted to SR and the risk of thromboembolism can be reduced.…”

Section: Study Limitationsmentioning

confidence: 99%

See 1 more Smart Citation

Prognostic Predictors of Sinus Rhythm Control by Amiodarone and Electrical Cardioversion in Patients Undergoing Percutaneous Transluminal Mitral Valvuloplasty for Rheumatic Atrial Fibrillation

Guo

Hang

Chang

et al. 2007

Circ J

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Section: Predictors Of Successful Maintenance Of Sr In Rheumatic Af Asupporting

confidence: 92%

Section: Study Limitationsmentioning

confidence: 99%

Prognostic Predictors of Sinus Rhythm Control by Amiodarone and Electrical Cardioversion in Patients Undergoing Percutaneous Transluminal Mitral Valvuloplasty for Rheumatic Atrial Fibrillation

Guo

Hang

Chang

et al. 2007

Circ J

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“…39 Factors that influence procedure success include larger left atrial size, longer duration of AF, and choice of lesion set in permanent AF. 40,41 The development of new techniques and operations for surgical treatment of AF has caused a change in cardiac surgical practice. At the Cleveland Clinic, our current policy is to perform ablation in almost all patients coming to the operating room with preexisting AF.…”

Section: New Approaches For Surgical Af Ablationmentioning

confidence: 99%

Advances in the surgical treatment of atrial fibrillation

Gillinov

McCarthy

2004

Cardiology Clinics

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Abstract-Atrial fibrillation (AF) is the most common sustained arrhythmia. It is associated with increased risks of death and stroke; most strokes in AF patients are thought to arise from thrombi in the left atrial appendage. Surgical ablation of AF includes excision of the left atrial appendage and is an effective means of treating this arrhythmia, with the classic Maze procedure curing AF in Ͼ90% of patients and virtually eliminating the risk of late stroke. A complex but safe operation, the Maze procedure has been applied by relatively few surgeons. Key Words: ablation Ⅲ atrial fibrillation Ⅲ stroke A trial fibrillation (AF) currently affects Ϸ2.4 million Americans; this number is expected to increase to Ͼ5.6 million by 2050. 1 The prevalence of AF increases with increasing patient age, and recent data from the Framingham Heart Study suggest that the lifetime risks for development of AF are 1 in 4 for men and women aged Ն40 years. 2 This epidemic has a growing impact on the healthcare system and a multibillion dollar cost. The clinical consequences of AF are well documented. AF is associated with reduced life expectancy and increases the risk of stroke 5-fold, accounting for Ϸ15% of all strokes nationally. 3-8 These AF-related strokes are a major challenge and a focus of several clinical trials investigating strategies for primary and secondary prevention. 4 Currently, antithrombotic therapy is the mainstay for stroke prevention in AF patients.Although there is currently some consensus concerning pharmacological strategies for stroke prevention in AF patients, choice of therapy for the heart rhythm is controversial and evolving. 9,10 Available antiarrhythmic therapies inconsistently restore sinus rhythm and are associated with complications. In fact, the risks associated with antiarrhythmic drug therapy may counterbalance the potential benefit of restoration of sinus rhythm. 9,10 These observations, coupled with increased understanding of the pathogenesis of AF, have resulted in the development of interventional strategies to restore sinus rhythm. Both catheter-based and surgical approaches have demonstrated effectiveness in this regard. Developed by Dr James Cox, the classic Maze procedure is the predicate operation for ablation of AF; long-term data suggest that the Maze procedure eliminates AF in Ͼ90% of patients. 11-14 Despite these unmatched results, the complexity and time associated with the Maze procedure have prevented widespread application by surgeons.Recently, however, there has been increased interest in direct surgical ablation of AF, fueled by technological advances and demonstration that the pulmonary veins and left atrium are the drivers of AF in most patients. 15 New ablation technologies enable surgeons to perform pulmonary vein isolation, create strategically placed, linear left atrial lesions, and excise the left atrial appendage rapidly and safely. 16 -23 Alternate energy sources used to create lines of conduction block and replace surgical incisions of the Maze procedure include radio...

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“…Atriyal fibrilasyon ve sol atriyal çap ile ilgili yapılan çalışmalarda; nonvalvuler AF'si olan hastalarda sol atriyal çap 47 mm ölçülmüştür 11 . Radyofrekans ablasyonla ilgili yapılan bazı araştırmalarda, sol atriyal büyüklüğün başarıyı etkilediği bildirilmesine rağmen, diğer araştırmacılar tarafından doğrulanmamıştır 12 . Çapı 5 cm'nin altında olan hastalarda sinüs ritmine dönüş, 5 cm' nin üzerinde olan hastalara göre yüksek bulunmuş ancak; hasta sayısı az olduğundan ististiksel olarak anlamlı bulunmamıştır.…”

Section: Discussionunclassified

Atriyal fibrilasyonun cerrahi tedavisinde azot bazlı kriyoablasyonun güvenirliği ve etkililiği

Uncu¹,

Ocak²,

Samsa³

et al. 2016

Cukurova Med J

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AbstractÖz Purpose: Chronic Atrial Fibrillation (AF) is the most prevalent arrhytmia in patients undergoing cardiac surgery. In this study we aim to share our cryoablation experiences. Material and Methods:We performed 25 cryoablations during cardiac surgery in Adana Numune Education and Research Hospital between September 2013 and July 2014. Patients evaluated retrospectively. The operations were performed with the use of cardiopulmonary bypass (CPB) and cold blood cardioplegia. Results: Fourteen mitral valve replacement, 7 aortic valve replacement and mitral valve replacement, 1 aortic valve replacement and tricuspid repair, 2 coronary artery bypass grafting, 1 coronary artery bypass grafting and aortic valve repair were applied. A -50-(-90) degrees of cryoprobe temperature was applied about 120 seconds. No complications developed in any of the patiens. Postoperative first day, first week, third month and after one year electrocardiography (ECG) of the patiens has evaluated. The corelation between preoperative left atrial diameter (M mode echocardiography) and postoperative first year atrial fibrillation has been investigated with corelation analysis. After one year controlls showed that 17 of 25 patient restored sinus rhytm and 8 of 25 patiens has still atrial fibrillation rhytm. Conclusion: Cryoablation using nitrous oxide based device for the treatment of atrial fibrillation has been applied recently and we consider that it is safe and effective.Amaç: Kronik atriyal fibrilasyon populasyonda olduğu kadar açık kalp cerrahisinde de sık görülen bir aritmidir. Bu çalışmamızda atriyal fibrilasyonun cerrahi tedavisinde uygulanan azot bazlı kriyoablasyonun güvenilirliğini ve etkinliğini araştırdık. Gereç ve Yöntem: Adana Numune Eğitim ve AraştırmaHastanesi'nde Eylül 2013-Temmuz 2014 yılları arasında 25 hastaya kriyoablasyon uygulandı. Hastalar retrospektif olarak değerlendirildi. Tüm hastalara operasyonlar kardiyopulmoner bypass altında ve kan kardiyopleji kullanılarak yapıldı. Bulgular: Ondört hastaya mitral kapak replasmanı, 7 hastaya aort ve mitral kapak replasmanı, 1 hastaya aort kapak replasmanı ve triküspid kapak tamiri, 2 hastaya koroner arter bypass greftleme, 1 hastaya koroner arter bypass greftleme ve aort kapak replasmanı yapıldı. Kriyoablasyon probu -50-(-90) dereceye kadar soğutulup yaklaşık 120 saniye uygulanarak kriyoablasyon işlemi tamamlandı. Hastaların hiçbirinde komplikasyon gelişmedi. Operasyona alınan hastaların postoperatif 1.gün, 1. hafta, 3.ay ve 1 yıl sonraki elektrokardiyografileri incelendi.1 yıl sonra 17 hastada sinüs ritmi, 8 hastada atriyal fibrilasyonun devam ettiği görüldü. Preoperatif sol atriyal çap (m mod ekokardiyografi) ile postoperatif 1.yılda sinüs ritmine dönüş arasında korelasyon analizi yapıldı. Sol atriyal çap azaldıkça, atriyal fibrilasyonda da azalma görüldü. Tartışma: Azot bazlı kriyoablasyon tedavisi yeni bir uygulama olmakla beraber, güvenilir ve etkin olduğunu düşünmekteyiz.

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Atrial Size Reduction as a Predictor of the Success of Radiofrequency Maze Procedure for Chronic Atrial Fibrillation in Patients Undergoing Concomitant Valvular Surgery

Abstract: Atrial size reduction appears to predict the success of sinus conversion with the RF maze procedure used in conjunction with valvular surgery.

Cited by 87 publications

References 4 publications

Prognostic Predictors of Sinus Rhythm Control by Amiodarone and Electrical Cardioversion in Patients Undergoing Percutaneous Transluminal Mitral Valvuloplasty for Rheumatic Atrial Fibrillation

Prognostic Predictors of Sinus Rhythm Control by Amiodarone and Electrical Cardioversion in Patients Undergoing Percutaneous Transluminal Mitral Valvuloplasty for Rheumatic Atrial Fibrillation

Advances in the surgical treatment of atrial fibrillation

Atriyal fibrilasyonun cerrahi tedavisinde azot bazlı kriyoablasyonun güvenirliği ve etkililiği

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