Surgical Treatment of Atrial Fibrillation in Patients with Rheumatic Valve Disease

Abstract

ObjectiveTo assess heart rhythm and predictive factors associated with sinus rhythm after one year in patients with rheumatic valve disease undergoing concomitant surgical treatment of atrial fibrillation. Operative mortality, survival and occurrence of stroke after one year were also evaluated.MethodsRetrospective longitudinal observational study of 103 patients undergoing rheumatic mitral valve surgery and ablation of atrial fibrillation using uni- or bipolar radiofrequency between January 2013 and December 2014. Age, gender, functional class (NYHA), type of atrial fibrillation, EuroSCORE, duration of atrial fibrillation, stroke, left atrial size, left ventricular ejection fraction, cardiopulmonary bypass time, myocardial ischemia time and type of radiofrequency were investigated.ResultsAfter one year, 66.3% of patients were in sinus rhythm. Sinus rhythm at hospital discharge, lower left atrial size in the preoperative period and bipolar radiofrequency were associated with a greater chance of sinus rhythm after one year. Operative mortality was 7.7%. Survival rate after one year was 92.3% and occurrence of stroke was 1%.ConclusionAtrial fibrillation ablation surgery with surgical approach of rheumatic mitral valve resulted in 63.1% patients in sinus rhythm after one year. Discharge from hospital in sinus rhythm was a predictor of maintenance of this rhythm. Increased left atrium and use of unipolar radiofrequency were associated with lower chance of sinus rhythm. Operative mortality rate of 7.7% and survival and stroke-free survival contribute to excellent care results for this approach.

Which Method to Use for Surgical Ablation of Atrial Fibrillation Performed Concomitantly with Mitral Valve Surgery: Radiofrequency Ablation versus Cryoablation

“…Left atrium diameter was greater than 50.5 mm in 12 (85.7%) of the 14 patients with recurrent AF. Our results are similar to those of Chavez et al [ 11 ] .…”

“…[ 10 ] , maintenance rates of sinus rhythm for one year follow-up after Cox maze III and IV procedures were found to be 96% and 93%, respectively. The success rate of concomitantly performed AF ablations was 67-84% in retrospective reports [ 11 ] . The variation in the studies was due to different lesion lines, different sources of energy, surgeon experience and follow-up strategies.…”

Characteristics, Mechanism and Long-Term Ablation Outcome of Atrial Tachycardias After Mitral Valvular Surgery and Concomitant Cox-MAZE IV Procedure

“…This would generate "triggers" for ATs. 11) Compared with previous reports, 3,5) R-ATs in the RA were located mostly around the TA in our study. The present Cox-Maze IV procedure in these patients did not include a posterior intercaval incision as in the Cox-Maze III procedure.…”

Incidence, etiology, and outcomes of pre- and post-operative atrial fibrillation in mitral valve procedures: a review

“…According to the STS guidelines, concomitant surgical ablation is a Class I, Level A recommendation for patients undergoing MV surgery with pre-operative atrial fibrillation due to its effectiveness in restoring sinus rhythm without increased operative morbidity and mortality [53] . Surgical ablation involves creating lesions in the right and left atria, most commonly around the pulmonary veins, to disrupt the electrical conduction pathways of atrial fibrillation and can be performed through a cut-and-sew-technique, radiofrequency ablation, or cryoablation [53,59,60] . The outcomes of concomitant surgical ablation for patients with pre-operative atrial fibrillation are detailed in Sections 1.4.2. and 1.4.6.…”