Atrial function after left atrial epicardial cryoablation for atrial fibrillation in patients undergoing mitral valve surgery

• Published in: Journal of interventional cardiac electrophysiology 2012, Vol.33 (1), p.85-91
• Main Authors: Johansson, Birgitta, Bech-Hanssen, Odd, Berglin, Eva, Blomström, Per, Holmgren, Anders, Jensen, Steen M., Källner, Göran, Nilsson, Leif, Thelin, Stefan, Karlsson, Thomas, Edvardsson, Nils, Blomström-Lundqvist, Carina
• Format: Article
• Language: English
• Subjects: Aged; Atrial Appendage - surgery; Atrial fibrillation; Atrial Fibrillation - complications; Atrial Fibrillation - diagnostic imaging; Atrial Fibrillation - physiopathology; Atrial Fibrillation - surgery; Atrial function; Atrial Function, Left; Cardiology; Clinical Medicine; Cryoablation; Cryosurgery; Echocardiography, Doppler; Female; Heart Atria - diagnostic imaging; Heart Atria - surgery; Heart Ventricles - diagnostic imaging; Humans; Klinisk medicin; Male; Medicin och hälsovetenskap; Medicine; Medicine & Public Health; Middle Aged; Mitral Valve - surgery; Mitral Valve Insufficiency - complications; Mitral Valve Insufficiency - diagnostic imaging; Mitral Valve Insufficiency - surgery; Pericardium - surgery; Ventricular Function, Left
• ISSN: 1383-875X; 1572-8595; 1572-8595
• DOI: 10.1007/s10840-011-9605-x

Purpose To explore the effects on atrial and ventricular function of restoring sinus rhythm (SR) after epicardial cryoablation and closure of the left atrial appendage (LAA) in patients with mitral valve disease and atrial fibrillation (AF) undergoing surgery. Methods Sixty-five patients with permanent AF were randomized to mitral valve surgery combined with left atrial epicardial cryoablation and LAA closure (ABL group, n  = 30) or to mitral valve surgery alone (control group, n  = 35). Two-dimensional and Doppler echocardiography were performed before and 6 months after surgery. Results At 6 months, 73% of the patients in the ABL group and 46% of the controls were in SR. Patients in SR at 6 months had a reduction in their left ventricular diastolic diameter while the left ventricular ejection fraction was unchanged. In patients remaining in AF, the left ventricular ejection fraction was lower than at baseline. The left atrial diastolic volume was reduced after surgery, more in patients with SR than AF. In patients in SR, the peak velocity during the atrial contraction and the reservoir function were lower in the ABL group than in the control group. Conclusions In patients in SR, signs of atrial dysfunction were observed in the ABL but not the control group. Atrial dysfunction may have existed before surgery, but the difference between the groups implies that the cryoablation procedure and/or closure of the LAA might have contributed.