BackgroundAtrial fibrillation frequently affects patients with valvular heart disease.
Ablation of atrial fibrillation during valvular surgery is an alternative
for restoring sinus rhythm.ObjectivesThis study aimed to evaluate mid-term results of successful atrial
fibrillation surgical ablation during valvular heart disease surgery, to
explore left atrium post-ablation mechanics and to identify predictors of
recurrence.MethodsFifty-three consecutive candidates were included. Eligibility criteria for
ablation included persistent atrial fibrillation <10 years and left
atrium diameter < 6.0 cm. Three months after surgery, echocardiogram,
24-hour Holter monitoring and electrocardiograms were performed in all
candidates who maintained sinus rhythm (44 patients). Echo-study included
left atrial deformation parameters (strain and strain rate), using
2-dimensional speckle-tracking echocardiography. Simultaneously, 30 healthy
individuals (controls) were analyzed with the same protocol for left atrial
performance. Significance was considered with a P value of < 0.05.ResultsAfter a mean follow up of 17 ± 2 months, 13 new post-operative cases
of recurrent atrial fibrillation were identified. A total of 1,245 left
atrial segments were analysed. Left atrium was severely dilated in the
post-surgery group and, mechanical properties of left atrium did not recover
after surgery when compared with normal values. Left atrial volume (≥
64 mL/m2) was the only independent predictor of atrial
fibrillation recurrence (p = 0.03).ConclusionsLeft atrial volume was larger in patients with atrial fibrillation recurrence
and emerges as the main predictor of recurrences, thereby improving the
selection of candidates for this therapy; however, no differences were found
regarding myocardial deformation parameters. Despite electrical maintenance
of sinus rhythm, left atrium mechanics did not recover after atrial
fibrillation ablation performed during valvular heart disease surgery.
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