Concomitant anti-arrhythmic procedures to treat permanent atrial fibrillation in CABG and AVR patients are as effective as in mitral valve patients

• Published in: European journal of cardio-thoracic surgery 2005-05, Vol.27 (5), p.841-846
• Main Authors: Khargi, Krishna, Lemke, Bernd, Deneke, Thomas
• Format: Article
• Language: English
• Subjects: Adult; Aortic Valve - surgery; Atrial fibrillation; Atrial Fibrillation - surgery; Catheter Ablation; Coronary Artery Bypass; Echocardiography; Electrocardiography; Electrophysiology; Follow-Up Studies; Heart Valve Prosthesis Implantation - methods; Humans; Logistic Models; Maze; Middle Aged; Mitral Valve - surgery; Radiofrequency; Survival Rate; Treatment Outcome; Valve surgery
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2004.12.041

Objective: Concomitant anti-arrhythmic procedures, to treat permanent atrial fibrillation, are not routinely performed in non-mitral valve surgery, such as coronary artery bypass grafting (CABG) and aortic valve (AVR) procedures. This study evaluated the sinus rhythm (SR) conversion rate of a concomitant anti-arrhythmia procedure in non-mitral valve surgery compared to mitral valve surgery. Methods: Between 1997 and 2003, 128 patients with a documented permanent atrial fibrillation had a concomitant anti-arrhythmic procedure using unipolar endocardial radiofrequency ablation; 65 mitral valve surgery (group I) and 63 aortic valve surgery or CABG (group II). Follow-up was complete and included standard ECG and echocardiogram at 3, 6, 12 months and each consecutive year. Stability of SR was confirmed with a 24-h ECG registration. Results: Type of procedures was MVR 42 (32.8%), MVP 23 (18.0%), CABG 40 (31.2), AVR 21 (16.4%), other 2 (1.6%). Thirty-day mortality for groups I and II were 4.6% (3/65) and 3.2% (2/63). Group II patients were distinctly older (69.3 versus 64.8 years; P=0.04), but the size of the left atrium was smaller (45.9 versus 52.4mm; P=0.0001) and the aortic cross-clamp time was shorter (91 versus 99min; P=0.05). The cumulative postoperative SR percentages for the groups I and II patients at 12 months were 71 versus 79%. A bi-atrial contraction was observed in 65.6% (21/32) and 68.3% (28/41) of the groups I and II patients, who had a stable SR. The mean (SD) follow-up for groups I and II was 24.4 (19.4) and 21.0 (17.2) months. The cumulative survival rate at 1, 2 and 3 years for groups I and II were 85 versus 88%, 83 versus 85%, 79 versus 85% (log-rank test P=0.60). Conclusion: A concomitant anti-arrhythmic procedure in CABG and AVR patients is as effective as in mitral valve patients, although these patients tend to be older, but with a smaller left atrial size.