Tratamento cirúrgico da fibrilação atrial por isolamento da parede posterior do átrio esquerdo em doentes com valvopatia mitral reumática crônica: um estudo randomizado com grupo controle

Abstract

a 6 meses, idade < a 60 anos e diâmetro atrial esquerdo < a 65 mm. Os pacientes foram distribuídos aleatoriamente em dois grupos: tratamento cirúrgico valvar (grupo controle) e tratamento cirúrgico valvar associado ao isolamento da parede posterior do átrio esquerdo mediante técnica de "corte e sutura" (grupo tratado). RESULTADOS: Foram operados 29 indivíduos, sendo que 27 (13 do grupo controle e 14 do grupo tratado), foram acompanhados regularmente. Os pacientes dos dois grupos não diferiram em relação às suas características basais. O tempo de seguimento médio foi de 11,5 meses no grupo controle e de 10,3 meses no grupo tratado. As freqüências cumulativas de pacientes livres de fibrilação atrial foram significativamente maiores no grupo tratado tanto na fase peri-operatória (p= 0,0035) quanto na fase tardia (p= 0,0430). CONCLUSÃO: O isolamento cirúrgico da parede posterior do átrio esquerdo envolvendo os óstios das veias pulmonares é uma forma efetiva de tratamento da fibrilação atrial na valvopatia mitral reumática.]]>

Efficiency and safety of ablation procedure for the treatment of atrial fibrillation in valve surgery

“…All of the included studies were RCTs (level 1 evidence) [10–23] . Nine studies had enrolled more than 50 patients (range, 60–260 patients), [10–13,16–19,21] whereas only 5 studies had fewer than 50 patients (range, 29–49 patients) [14,15,20,22,23] .…”

“…[14,15,20,22,23] Eight studies used radiofrequency ablation, [13][14][15][17][18][19]21,23] 3 studies used cryoablation, [11,12,17] 4 studies used Cox-Maze cut-andsew, [10,16,20,22] and only 1 study reported patients undergoing pulmonary vein isolation. [16] Permanent AF; persistent AF; and a mixture of permanent, persistent, and paroxysmal AF populations were evaluated in 7, [11,[14][15][16]19,20,23] 5, [10,12,14,21,22] and 1 study, [18] respectively. One of the studies reported a follow-up of greater than 3 years (60 months).…”

“…[10][11][12][13][14][15][17][18][19][20][21] SR was the primary endpoint in 8 studies, [11,[14][15][16][18][19][20]23] whereas AF-free survival was the primary endpoint in 6. [10,12,13,17,21,22] Outcomes of SR at discharge, 3 to 6 months, and ≥1 year were reported in 9, [14][15][16][17][18][20][21][22][23] 10, [13][14][15][17][18][19][20][21][22][23] and 11 studies, [13][14][15][16][17][18][19]…”

Treatment of Chronic Atrial Fibrillation During Surgery for Rheumatic Mitral Valve Disease

“…Vasconcelos et al [15] performed a study to evaluate the effectiveness of surgical isolation of the left atrial posterior wall involving the ostia of the pulmonary veins for the treatment of atrial fibrillation in patients with rheumatic mitral valve disease.…”

“…In the Vasconcelos et al [15] study, the inclusion of a control group permitted the establishing of the isolation of the posterior wall of the left atrium, encompassing the ostia of the pulmonary veins, used concomitantly with the valvular surgical treatment in patients with chronic rheumatic heart disease. It is a safe and effective procedure in the treatment of atrial fibrillation, promoting a reduction in the incidence of recurrence of arrhythmia, both in the perioperative phase in late stage.…”