Right atrial lesions do not improve the efficacy of a complete left atrial lesion set in the surgical treatment of atrial fibrillation, but they do increase procedural morbidity

Abstract

Objective Some have suggested the superiority of biatrial versus left atrial lesions. We sought to analyze our experience. Methods We retrospectively reviewed 305 consecutive patients from 2007 to 2011. Rhythm success was defined as freedom from atrial fibrillation (AF) or flutter determined by 12-lead electrocardiograms at 3-month intervals. Lesions sets were pulmonary vein isolation (PVI), left-extended (PVI + mitral valve annulus [MV] lesion ± left atrial appendage lesion [LAA]) or biatrial-extended (right atrial ablation + PVI + MV ± LAA). Results The success rates of PVI, left-extended, and biatrial-extended lesions were as follows: at 3 months, 56.7%, 74.7%, and 79.4% (P = .003); at 6 months, 56.9%, 72.9%, and 74.6% (P = .02); at 9 months, 54.6%, 72.5%, and 83.3% (P < .001); and at 12 months, 52.6%, 76.1%, and 80.0% (P < .001). Biatrial lesions had a higher rate of pacemaker placement than did left atrial lesions (16.5% vs 7.5%; P = .02). When we grouped patients by left lesion (PVI, PVI + MV, PVI + MV + LAA) irrespective of right atrial ablation, success was as follows: 3 months, 57.9%, 71.1%, and 87.8% (P < .01); 6 months, 58.1%, 71.6%, and 77.6% (P = .03); 9 months, 55.9%, 71.3%, and 89.6% (P < .01); and 12 months, 54.1%, 74.7%, and 83.7% (P < .01). Conclusions PVI is associated with lower rhythm success than an extended left atrial lesion set. The addition of a right atrial lesion to an extended left atrial lesion set does not improve efficacy, but it does increase the rate of pacemaker placement for sinus dysfunction. Adding an LAA lesion may confer additional efficacy when added to a lesion set that includes PVI + MV.

Surgical Techniques Used for the Treatment of Atrial Fibrillation

“…These authors found similar differences between lesion sets 45 when operations were performed in patients undergoing concomitant mitral valve surgery. An ongoing NIH sponsored clinical trial comparing biatrial ablation, extended LA ablation and no treatment in AF patients undergoing mitral valve surgery should help clarify this issue (ClinicalTrials.gov identifier: NCT00903370).…”

“…45 Unfortunately, because of uncorrected differences in baseline patient characteristics between groups, the heterogeneity of lesion sets and ablation technology, the performance of multiple subanalyses, rhythm follow-up with only electrocardiography and failure to report freedom from AADs, these data are extremely difficult to interpret. Moreover, the significant differences between groups suggest that there was a fairly prominent uncontrolled selection bias in what lesion sets were chosen for different patients.…”

Biatrial ablation versus limited right atrial ablation for atrial fibrillation associated with atrial septal defect in adults

“…However, it remains unclear whether biatrial ablation is more effective and safer than limited left or right atrial ablation [8-10, 12, 13]. Soni lK et al [12] concluded that the addition of a right atrial lesion to an extended left atrial lesion set did not improve efficacy, but it did increase the rate of pacemaker placement for sinus dysfunction. conversely, Kim JB et al [13] considered that biatrial ablation was more effective for the restoration and maintenance of sinus rhythm without increasing the risk of postoperative complications.…”

Comparative analysis of the requirement for pacemaker implantation in the left atrial and biatrial concomitant ablation in patients with valvular heart disease

“…Недавние исследова-ния, включая два рандомизированных [1,5], вы-явили сопоставимую эффективность как лево-предсердной (ЛП), так и биатриальной (БА) аб-лации [6,7], в то же время другие исследования, включая два метаанализа, показали, что БА-аб-лация способствует более длительной свободе от возврата ФП [4,8,9]. Основным ограничением для выполнения БА-аблации является более вы-сокий риск имплантации искусственного води-теля ритма (электрокардиостимулятора -ЭКС) [6,8,10]. Некоторые авторы утверждают, что БА-аблацию разумно выполнять у пациентов с пер-систирующей или длительно персистирующей ФП [4,11,12].…”

“…Soni et al показано, что БА-схема фрагментации была ассоциирована с бо-лее высокой частотой случаев имплантации ЭКС (7,5% против 16,5%, р = 0,02), в том числе по причине дисфункции синусного узла (3,7% против 12,1%, р < 0,01), независимо от других операционных факторов [6]. В недавнем мета-анализе частота имплантации ЭКС в ЛП-и БА-группах составила 5,4 и 7,0% соответственно (р = 0,008) [8].…”